Ultrasound-guided bilateral rectus sheath block reduces early postoperative pain after laparoscopic gynecologic surgery: a randomized study.

Abstract

Rectus sheath block (RSB) is an anterior abdominal wall block that reduces postoperative pain associated with midline incisions. This study aims to investigate the effect of ultrasound-guided bilateral RSB (US-BRSB) on postoperative pain and analgesic consumption in patients undergoing laparoscopic gynecologic surgery. Sixty patients who underwent laparoscopic gynecologic surgery were allocated to RSB (n=30) or control (n=30) group. A bilateral US-BRSB procedure (30ml of 0.25% ropivacaine) was performed after induction of general anesthesia in the RSB group. The control group proceeded the surgery without sham block. All patients received fentanyl-based intravenous patient-controlled analgesia and rescue analgesics upon demand. Pain was scored by a blinded observer using a verbal numerical rating scale (VNRS) at rest while coughing at 0, 1, 6, 12, 24, and 48h after postanesthesia care unit (PACU) admission. The primary outcome was the total number of rescue analgesics used in the 48-h postoperative period. At 0h, VNRS were lower in the RSB group than in the control, both at rest (median VNRS 4.5 vs. 5, p=0.02) and while coughing (median VNRS 6 vs. 7, p=0.004). At 6h, VNRS scores were lower in the RSB group than in the control while coughing (median VNRS 3 vs. 5, p=0.01). Fentanyl use as rescue analgesics in the PACU was significantly lower in the RSB group than in the control (27.7±32.1 vs. 53.3±33.7µg, respectively; p=0.004). At 48h postoperatively, the total number of rescue analgesics administered were significantly fewer in the RSB group than in the control (2.5±2.5 vs. 3.9±2.6, respectively; p=0.04). US-BRSB reduces the immediate postoperative pain and opioid consumption during the early postoperative period. CLINICALTRIALS. NCT02476799, https://clinicaltrials.gov/ct2/show/NCT02476799 .