Ultrasound-guided rectus sheath block versus local infiltration in management of pain after single-incision laparoscopic cholecystectomy

Abstract

Background Single-incision laparoscopic cholecystectomy (SILC) allows decreasing the number of incisions and tissue trauma. Efforts have been made to decrease port incision pain, as it constitutes up to 70% of postoperative pain. Rectus sheath block provides effective analgesia to the midline. Aim The aim of the study was to evaluate the efficacy of ultrasound (U/S)-guided rectus sheath block for pain management following SILC surgery. Patients and methods A total of 50 patients undergoing elective SILC were allocated randomly into two groups: U/S-guided rectus sheath block, the R group, or local infiltration, the L group. All patients received the same general anesthetic technique. In the L group, port-site infiltration was made by the surgeon using 0.5% bupivacaine. In the R group, bilateral U/S-guided rectus sheath block was performed using 10 ml of 0.5% bupivacaine. Total fentanyl amount received intraoperatively was recorded. Patient Controlled Analgesia (PCA) morphine was used for postoperative analgesia and the morphine consumption was recorded. Lornoxicam was given as rescue analgesia and its time was recorded. Pain was measured by visual analogue score. Sedation score (from 0 awake to 5 unarousable) was used. Any adverse events were recorded. Results In all, 45 patients completed the study. Total amount of fentanyl was not different and no adverse events were reported. The number of patients who received rescue analgesia was not different. In addition, neither PCA start time nor PCA morphine consumption was different, whereas the total PCA morphine use in 24 h was lower in the R group. Conclusion U/S-guided rectus sheath block is an effective analgesic technique with morphine-sparing effect after SILC surgeries.