Ultrasound-guided Rectus Sheath Block Research Articles

The effect of ultrasound-guided rectus sheath block on postoperative analgesia in robot assisted prostatectomy: A randomized controlled trial.

Postoperative pain continues to represent an important problem even after minimally invasive robotic-assisted laparoscopic radical prostatectomy, which results in discomfort in the postoperative period and sometimes prolongs hospital stays. Regional anesthesia and analgesia techniques are used in addition to systemic analgesics with the multimodal approach in postoperative pain management. Ultrasound-guided fascial plane blocks are becoming increasingly important, especially in minimally invasive surgeries. Another important cause of discomfort is urinary catheter pain. The present randomized controlled study investigated the effect of rectus sheath block on postoperative pain and catheter-related bladder discomfort in robotic prostatectomy operations. This randomized controlled trial was conducted from March to August 2022. Written informed consent was obtained from all participants. Approval for the study was granted by the Clinical Research Ethics Committee. All individuals provided written informed consent, and adults with American Society of Anesthesiologists Physical Condition classification I to III planned for robotic prostatectomy operations under general anesthesia were enrolled. Following computer-assisted randomization, patients were divided into 2 groups, and general anesthesia was induced in all cases. Rectus sheath block was performed under general anesthesia and at the end of the surgery. No fascial plane block was applied to the patients in the non-rectus sheath block (RSB) group.Postoperative pain and urinary catheter pain were assessed using a numerical rating scale. Fentanyl was planned as rescue analgesia in the recovery room. In case of numerical rating scale scores of 4 or more, patients were given 50 µg fentanyl IV, repeated if necessary. The total fentanyl dose administered was recorded in the recovery room. IV morphine patient-controlled analgesia was planned for all patients. All patients' pain (postoperative pain at surgical site and urethral catheter discomfort) scores and total morphine consumption in the recovery unit and during follow-ups on the ward (3, 6, 12, and 24 hours) in the postoperative period were recorded. Sixty-one patients were evaluated. Total tramadol consumption during follow-up on the ward was significantly higher in the non-RSB group. Fentanyl consumption in the postanesthesia care unit was significantly higher in the non-RSB group. Total morphine consumption was significantly lower in the RSB group at 0 to 12 hours and 12 to 24 hours. Total opioid consumption was 8.81 mg in the RSB group and 19.87 mg in the non-RSB group. A statistically significant decrease in urethral catheter pain was noted in the RSB group at all time points. RSB exhibits effective analgesia by significantly reducing postoperative opioid consumption in robotic prostatectomy operations.

Preoperative versus postoperative ultrasound-guided rectus sheath block for acute postoperative pain relief after laparoscopy: A retrospective cohort study.

Although rectus sheath block (RSB) is routinely used in laparoscopic surgeries to reduce mid-abdominal pain, whether RSB should be performed before or after surgery remains unclear. Herein, the optimal timing for RSB in patients undergoing laparoscopic surgery was investigated. This retrospective cohort study analyzed the data of patients who underwent RSB during laparoscopic procedures at our hospital between January 2013 and December 2018. The primary outcome was the time to rescue analgesia within 24 hours postanesthesia. The patients were divided into preoperative (pre-) and postoperative (post-) RSB groups. A multivariable Cox proportional hazards regression model was used to analyze the time to rescue analgesia in the unmatched and propensity score (PS)-matched patient populations. In total, 609/14,284 patients were included (pre-RSB group, 227 patients; post-RSB group, 382 patients). After PS matching, 97 patients were assigned to both groups. Although the time from extubation to the first analgesic request was not significantly different between the 2 groups (322 vs 294 minutes, P = .57), the patients in the pre-RSB group showed a lower risk of postoperative first analgesic administration after PS matching (adjusted hazard ratio, 0.71; 95% confidence interval, 0.53-0.95; P = .023). Among patients undergoing laparoscopic surgery, those in the pre-RSB group tended to have a longer time to the first analgesic request and had a lower risk of analgesic administration within the first 24 hours than those in the post-RSB group. Thus, performing RSB preoperatively may be preferable.

Levobupivacaine concentration for the ultrasound-guided rectus sheath block in children undergoing umbilical skin incision: An up-and-down dose-finding study.

Levobupivacaine concentration for the ultrasound-guided rectus sheath block in children undergoing umbilical skin incision: An up-and-down dose-finding study.

Assessment of an Ultrasound-Guided Rectus Sheath Block in Foals: A Cadaveric Study

In neonatal equines, pathologies involving umbilical structures are an important cause of morbidity, and surgical removal of urachal remnants is a common procedure in clinical practice. Surgery involving the ventral abdominal wall can cause substantial pain, leading to complications and prolonged recovery. The objectives of this study were to describe a two-point bilateral ultrasound-guided rectus sheath block at the level of the umbilicus and to evaluate the extent of dye distribution in foal cadavers. Ten foal cadavers were included in the study, in which a bilateral two-point ultrasound-guided rectus sheath block was performed—one injection 5 cm cranially and a second one 5 cm caudally to the umbilicus. The injectate consisted of a mixture of iodinated contrast medium and blue dye at a volume of 0.25 mL kg−1 per injection point (total 1 mL kg−1). After the injection, computer tomography and subsequent dissection of the ventral abdominal wall were performed. The extension of the contrast medium, the number of stained nerves, and contamination of the abdominal cavity were evaluated. The cranio-caudal extension of the contrast ranged from 0.8 to 1.4 cm per milliliter of injectate. The most commonly stained ventral branches of spinal nerves were thoracic (Th) nerves 16, 17, and 18 (95%, 85%, and 80% of the nerves, respectively). Abdominal contamination was found in four animals. The results suggest that the block could provide periumbilical analgesia. Further studies with different volumes of injectate and living animals are warranted.

Cardiovascular changes, laboratory findings and pain scores in calves undergoing ultrasonography-guided bilateral rectus sheath block before herniorrhaphy: a prospective randomized clinical trial

BackgroundThe study aimed to assess the clinical utility of a multiparametric approach to measure the impact of bilateral ultrasound-guided rectus sheath blocks (RSB) on heart rate, serum cortisol concentrations, and pain in calves undergoing herniorraphy. Fourteen calves were randomly assigned to receive either the RSB (RSB group, n = 7, injected with 0.3 mL/kg of bupivacaine 0.25% and 0.15 µg/kg of dexmedetomidine per side) or a sham injection (CG group, n = 7, injected with an equivalent volume of sterile saline solution). Monitoring included (i) continuous Holter recording from 120 min pre-surgery to 120 min post-surgery; (ii) serum cortisol concentration (SC) at -150 min pre-surgery (baseline), induction time, skin incision, end of surgical procedure (EP-t), and then 30 min, 45 min, 60 min, 120 min, 360 min after recovery; (iii) UNESP-Botucatu pain evaluation at -150 min pre-surgery and 30 min, 45 min, 60 min, 120 min, 240 min, 360 min after recovery.ResultsA significant difference in the heart rate was observed within the RSB group, in the time frame between 120 min to induction compared to the time frame between induction to EP-t period. The SC concentration was significantly higher in the CG at the skin incision. Calves in the RSB group recorded significantly lower pain scores at 45 min, 60 min, 120 and 240 min after recovery.ConclusionsThe study demonstrated that monitoring heart rate and serum cortisol concentrations effectively quantified the effects of RSB during surgery. At the same time, the UNESP-Botucatu pain scale identified effects post-surgery when the calves regained consciousness. Overall, ultrasound-guided RSB appeared to enhance the well-being of calves undergoing herniorrhaphy.

Comparison between adenosine and magnesium sulfate as an adjuvant for ultrasound-guided rectus sheath block. A prospective randomized controlled study

ABSTRACT Background Rectus sheath block (RSB) is an effective nerve block. This study aimed to compare adenosine and magnesium sulfate as an adjuvant for ultrasound-guided RSB (UG-RSB). Methods This prospective controlled randomized trial was performed on 96 adult patients (ASA I and II) undergoing umbilical or epigastric hernia repair. The patients were assigned randomly to three equal groups and got bilateral UG-RSB. Adenosine group: using 20 ml bupivacaine hydrochloride 0.25% + 12 mg of adenosine (4 ml) +1 ml saline 0.9%. Magnesium group: using 20 ml bupivacaine hydrochloride 0.25% + 500 mg of magnesium sulfate (5 ml). Control group: using 20 ml bupivacaine hydrochloride 0.25% + 5 ml of saline 0.9%. Registration No.: 6/2018ANET17 Results A significant postoperative reduction of VAS up to 18 h was detected in the magnesium sulfate group and up to 12 h was detected in the adenosine group. A statistically significant prolongation of time to the first analgesia in magnesium and adenosine groups than control groups (483.44 ± 48.03 & 415.28 ± 29.81 than 325.31 ± 50.29, respectively), as well as the mean postoperative morphine consumption was 5.94 ± 1.61, 8.03 ± 1.0 and 16.69 ± 2.49 among magnesium, adenosine, and control groups, respectively. The postoperative complications were statistically significantly higher in the control group. Conclusion This study validates the effectiveness of adenosine versus magnesium sulfate as good adjuvants for improving the quality and duration of UG-RSB and reduction of postoperative narcotic requirements. However, the duration was relatively longer with magnesium sulfate.

Ultrasound-Guided Rectus Sheath Block versus Transversus Abdominus Plane Block for Post-Operative Analgesia in Elective Cesarean Section

Abstract Background Nerve root or myofascial irritation at the abdominal wall is a common cause of pain following surgeries such as cesarean section, cholecystectomy, prostatectomy, hysterectomy and transplant surgery. Aim of the Work The aim of this study is to test the efficacy of ultrasound guided TAP block versus ultrasound guided rectus sheath block as regards its efficacy, hemodynamic stability, onset of post-operative pain, amount of post-operative narcotics used. Patients and Methods In the current study eighty patients who received spinal anesthesia were included. Patients were divided randomly into two groups, each group consisted of 40 patients. Group A: Patients in this group received bilateral US guided TAP block at the end of surgery. Group B: Patients in this group received bilateral US guided rectus sheath block at the end of surgery. Results These result met with another study, Ayman Saleh et al which shows the time for first analgesic request (minutes) was significantly increased in TAP when compared to RS block groups (332.50±42.93 vs 220.10±21.51 minutes, respectively). Also, the total analgesic consumption (mg) was significantly reduced in TAP when compared to RS block groups respectively (90.40±27.02 vs 157.00±37.80 mg, respectively). Conclusion Ultrasound-guided TAP block was more effective than ultrasound-guided RS block in patients undergoing cesarean delivery with prolonged postoperative analgesia, less analgesics consumption and less postoperative nausea and vomiting.

Comparison of analgesic efficacy of perineural dexamethasone in rectus sheath block and intravenous dexamethasone with levobupivacaine in bilateral rectus sheath block for patients undergoing midline abdominal surgery: a randomized controlled trial

BackgroundDexamethasone is used in regional analgesia to prolong the duration of analgesia and anaesthesia. The perineural and intravenous (IV) dexamethasone in fascial plane block have conflicting results. The study aimed to compare analgesic efficacy of perineurally and intravenously dexamethasone in rectus sheath block (RSB). This prospective, double-blinded, randomized control study was conducted in 105 patients, equally divided in three groups. All the patients received ultrasound-guided RSB block with 20 ml of 0.25% levobupivacaine on each side. Additionally, in group A, 1-ml normal saline (NS) on each side in RSB block and 2-ml NS IV; in group B, 4-mg dexamethasone on each side in RSB block and 2-ml NS IV; and in group C, 1-ml NS on each side in RSB block and 8-mg dexamethasone IV.The primary objective of the study was the duration of analgesia, and secondary objectives were total morphine consumption in the first 24 h, numeric rating scale (NRS) scores at rest and on cough, complications and patient’s satisfaction score.ResultsThe duration of analgesia was maximum in group B (935.91 ± 121.82 min) and then in group C (730.31 ± 129.64 min) and group A (418.34 ± 29.22 min) (P < 0.0001). The morphine consumption and mean NRS score (at rest and cough) were lowest in group B and then group C and group A (P < 0.0001).ConclusionsThe perineural dexamethasone as an adjuvant to levobupivacaine prolongs the duration of analgesia with decreased analgesic requirements compared to intravenous dexamethasone in bilateral RSB in patients undergoing midline laparotomy surgery.

Effect of a Local Anesthetic Injection Kit on Pain Relief and Postoperative Recovery After Transumbilical Single-Incision Laparoscopic Cholecystectomy.

This study was conducted to explore whether incisional infiltration using a local anesthetic injection kit could better relieve postoperative pain and enhance the quality of recovery compared with ultrasound-guided rectus sheath block (RSB) or conventional local anesthetic infiltration in patients undergoing transumbilical single-incision laparoscopic cholecystectomy (SILC). A total of 60 patients undergoing SILC with American Society of Anesthesiology functional status scores of I-II were randomized into the rectus sheath block group (RSB group), conventional local wound infiltration group (LAI-I group) and incisional infiltration using a local anesthetic injection kit group (LAI-II group). The primary outcomes were the patient-controlled intravenous analgesia (PCIA) demand frequency within 48 hours after the operation and postoperative pain measured by a visual analog scale (VAS) at 2 h, 4 h, 8 h, 24 h, and 48 h after surgery. Secondary outcomes were the total procedure times, cumulative consumption of anesthetic drugs, duration of surgery, duration and awaking time of anesthesia, early recovery indicator and side effects. The PCIA demand frequency in LAI-II group was significantly lower compared with patients in the RSB and LAI-I group (both P < 0.001). Moreover, the total procedure times in LAI-I and LAI-II group was significantly shorter than that in the RSB group (P < 0.001, respectively), but it was comparable between LAI-I and LAI-II group (P = 0.471). Though lower at 2h and 4h postoperative in LAI-II group, pain scores at each time point had no statistical differences among three groups. There were no significant differences among three groups for other outcomes as well. The effect of ultrasound-guided RSB and conventional local anesthetic infiltration in SILC patients were found to be similar in terms of relieving postoperative pain and promoting recovery. Incisional infiltration using a local anesthetic injection kit can significantly reduce the demand frequency of PCIA, which serves as a rescue analgesic.

The Ropivacaine Concentration Required for Ultrasound-Guided Rectus Sheath Block in Pediatric Patients Undergoing Single-Incision Laparoscopic Hernia Repair: A Sequential Allocation Dose-Finding Study.

The local anesthetic concentration required for ultrasound-guided rectus sheath block (RSB) in children remains unknown. Knowledge of appropriate ropivacaine concentration can help clinicians reduce local anesthetic toxicity risk when performing ultrasound-guided RSB in children. This study aimed to determine the appropriate ropivacaine concentration for ultrasound-guided RSB in children undergoing laparoscopic inguinal hernia repair. In this single-arm prospective study with an up-down sequential allocation design of binary response variables, 18 consecutive children aged 11 months to 7 years undergoing single-incision laparoscopic percutaneous extraperitoneal closure were assessed. Orotracheal intubation was performed without intravenous anesthesia or a neuromuscular relaxant. After intubation, ultrasound-guided RSB was performed with a ropivacaine dose of 0.30 ml/kg(0.15 ml/kgper side). Dixon's up-and-down method was used to determine the concentration, starting from 0.25% in 0.05% increments. Surgery commenced ≥15 min following RSB. Body movement or a 20% increase in heart rate or systolic blood pressure within 1 min of surgery initiation determined an unsuccessful RSB. The 95% effective concentration of ropivacaine needed for successful RSB was calculated using the probit test. The 95% effective concentration of ropivacaine needed for successful ultrasound-guided RSB was 0.31% (95% confidence interval, 0.25-7.29). The highest concentration of ropivacaine required for successful ultrasound-guided RSB in the group of patients in this study was 0.3%. The 95% effective concentration of ropivacaine (0.30 ml/kgtotal, 0.15 ml/kgper side) for ultrasound-guided RSB was 0.31% in children undergoing single-incision laparoscopic surgery under general anesthesia.

How I do it: Ultrasound-guided rectus sheath blocks

How I do it: Ultrasound-guided rectus sheath blocks

Comparison of Ultrasound-Guided Rectus Sheath Block Versus Local Infiltration at The Port Sites and Intraperitoneal Instillation of 0.25% Bupivacaine for Post-Operative Pain Control After Laparoscopic Cholecystectomy

Comparison of Ultrasound-Guided Rectus Sheath Block Versus Local Infiltration at The Port Sites and Intraperitoneal Instillation of 0.25% Bupivacaine for Post-Operative Pain Control After Laparoscopic Cholecystectomy

Transversus Abdominis Plane Block Versus Rectus Sheath Block for Postoperative Pain After Caesarean Delivery: A Randomised Controlled Trial.

Postoperative analgesia in caesarean deliveries is becoming increasingly important, since early bonding between mother and infant can be established with effective postoperative analgesia while preventing the unpleasant effects of pain. Additionally, inadequate postoperative analgesia is associated with chronic pain and postpartum depression. The primary objective of this study was to compare the analgesic effects of transversus abdominis plane block and rectus sheath block in patients undergoing elective caesarean delivery. A total of 90 parturients with American Society of Anesthesia status I-II, aged 18-45 years, at >37 gestational weeks, and scheduled for elective caesarean delivery were included in the study. All patients received spinal anaesthesia. Parturients were randomised into 3 groups. Bilateral ultrasound-guided transversus abdominis plane block was performed on the transversus abdominis plane group, bilateral ultrasoundguided rectus sheath block on the rectus sheath group, and no block on the control group. All patients were given intravenous morphine through a patient-controlled analgesia device. A pain nurse, blinded to the study, recorded the cumulative morphine consumption and pain scores during resting and coughing using a numerical rating scale at postoperative hours 1, 6, 12, and 24. Numerical rating scale values recorded during rest and coughing were lower in the transversus abdominis plane group at postoperative hours 2, 3, 6, 12, and 24 (P < .05). Morphine consumption was lower in the transversus abdominis plane group at postoperative hours 1, 2, 3, 6, 12, and 24 (P < .05). Transversus abdominis plane block provides effective postoperative analgesia in parturients. However, rectus sheath block provides inadequate postoperative analgesia in parturients who undergo caesarean delivery.

Clinical efficacy of an ultrasound-guided bilateral rectus sheath block for umbilical hernia repair in calves: A prospective randomized trial.

Surgical umbilical hernia repair is a frequent procedure in newborn calves, requiring mandatory pain management. This study aimed to develop an ultrasound-guided rectus sheath block (RSB) and to evaluate its clinical efficacy in calves undergoing umbilical herniorrhaphy under general field anesthesia. Gross and ultrasound anatomy of the ventral abdomen and the diffusion of a new methylene blue solution after injection within the rectus sheath were described in seven fresh calf cadavers. Then, fourteen calves undergoing elective herniorrhaphy were randomly assigned to receive either bilateral ultrasound-guided RSB with 0.3 mL/kg of bupivacaine 0.25% and 0.15 µg/kg of dexmedetomidine or 0.3 mL/kg of 0.9% NaCl (control). Intraoperative data included cardiopulmonary variables and anesthetic requirements. Postoperative data included pain scores, sedation scores and peri-incisional mechanical threshold assessed by force algometry at specific time points after anesthetic recovery. Treatments were compared using Wilcoxon rank-sum, Student's t-test, and Cox proportional hazard model as appropriate. Mixed effect linear models on rank, with random effect calf; fixed effects time, treatment, and their interaction were used to compare pain scores and mechanical thresholds over time. Significance was set at p = 0.05. Calves receiving RSB recorded lower pain scores between 45 - 120 minutes (p < 0.05) and at 240 min after recovery (p = 0.02). And they recorded higher mechanical thresholds between 45 and 120 min after surgery (p < 0.05). Ultrasound-guided RSB provided effective perioperative analgesia in calves undergoing herniorrhaphy under field conditions.

Evaluating Patterns of Injectate Spread After Rectus Sheath Block: A Cadaveric Dissection Study.

This cadaveric dye study assesses the effect of volume and number of injections on the spread of solution after ultrasound-guided rectus sheath injections. In addition, this study evaluates the impact of the arcuate line on solution spread. Ultrasound-guided rectus sheath injections were performed on seven cadavers on both sides of the abdomen, for a total of 14 injections. Three cadavers received one injection of 30 mLof a solution consisting of bupivacaine and methylene blue at the level of the umbilicus. Four cadavers received two injections of 15 mLof the same solution, one midway between the xiphoid process and umbilicus and one midway between the umbilicus and pubis. Six cadavers were successfully dissected and analyzed for a total of 12 injections, while one cadaver was excluded due to poor tissue quality that was inadequate for dissection and analysis. There was a significant spread of solution with all injections caudally to the pubis without limitation by the arcuate line. However, a single 30 mLinjection showed inconsistent spread to the subcostal margin in four of six injections, including in a cadaver with an ostomy. A double injection of 15 mLshowed consistent spread from xiphoid to pubis in five of six injections, except in a cadaver with a hernia. Injections deep to the rectus abdominis muscle, using the same technique as an ultrasound-guided rectus sheath block, achieve spread along a large and continuous fascial plane without limitation by the arcuate line and may provide coverage of the entire anterior abdomen. A large volume is necessary for complete coverage and spread is improved with multiple injections. We suggest that two injections with a total volume of at least 30 mLper side may be needed to achieve adequate coverage in the absence of preexisting abdominal abnormalities.

Evaluation of pre-operative rectus sheath block with bupivacaine for analgesia in cats undergoing ovariohysterectomy

Introduction: This study determined the effect of preoperative ultrasound-guided rectus sheath block (USRSB) on intra-operative hemodynamic responses to surgical stimulation and its effect on post-operative pain as compared to a standard treatment with robenacoxib.

Complications and Technical Consideration of Ultrasound-Guided Rectus Sheath Blocks: A Retrospective Analysis of 4033 Patients.

Although the ultrasound-guided rectus sheath block (RSB) is usually regarded as an easy and safe procedure in clinical settings, there is currently no report on complications incidence. Therefore, the present study investigated complications in a large cohort and described the technical considerations to minimize complications of real-time ultrasound-guided RSBs. This was a retrospective cohort study of patients who underwent real-time ultrasound-guided RSBs for perioperative pain control in laparoscopic surgery with an umbilical port between February 1, 2017, and February 28, 2021, at the Asan Medical Center in South Korea. All RSBs were performed bilaterally using a 23-gauge Quincke needle, and a bilateral 2-block placement was regarded as 1 RSB. Patient data, including demographics, preoperative laboratory data, preoperative antiplatelet or anticoagulant medication with the duration of discontinuation, and type of surgery, were collected to show the study population characteristics and explore potential factors associated with adverse events such as hematoma. Ultrasound images of patients and adverse events of RSBs, including extrarectus sheath injections, vascular injuries, bowel injury, or local anesthetic systemic toxicity, were also analyzed accordingly. A total of 4033 procedures were analyzed. The mean body mass index of the patients was 24.1 (21.8-26.5) kg/m2. The preoperative laboratory data were within normal range in 4028 (99.9%) patients. Preoperative antiplatelets or anticoagulants were administered in 17.3% of the patients. Overall, 96 complications (2.4%) were observed. Among them, extrarectus sheath injection occurred in 88 cases (2.2%), which included preperitoneal injection (0.9%) and intraperitoneal injection (1.3%). Vascular injuries constituted 8 cases (0.2%) and all vascular injuries resulted in hematoma: 7 cases of inferior epigastric artery injury with rectus sheath hematoma and 1 of inferior mesenteric artery injury with retroperitoneal hematoma. Bowel injury or local anesthetic systemic toxicity was not reported. In this study of RSBs performed on 4033 patients using a 23-gauge Quincke needle in patients with low body mass index, there were 8 cases (0.2%) of vascular injury, all of which accompanied hematoma.

Comparison of Postoperative Analgesic Efficacy of Ultrasound-Guided Bilateral Rectus Sheath Block With That of Local Anaesthetic Infiltration in Patients Undergoing Emergency Midline Laparotomy Surgeries: A Randomised Controlled Trial.

Purpose Rectus sheath block (RSB) is increasingly utilised as a part of multimodal analgesia in laparotomy surgeries. We proposed this study to compare the analgesic efficacy of ultrasound-guided bilateral RSB with local anaesthetic (LA) infiltration. The primary outcome was the visual analogue scale (VAS) at rest and cough. The secondary outcomes were the postoperative morphine consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV)and patient satisfaction score. Methods In our prospective, single-centre, randomised clinical trial, we enrolled a total of 100 patients undergoing emergency midline laparotomy surgeries. They were randomly allocated into two groups and were administered either LA infiltration (group L, n=50) or ultrasound-guided bilateral RSB (group R, n=50) with 15-20 ml of 0.25% bupivacaine end operatively.The categorical and ordinal variables were analysed using Chi-square/ Fisher's exact test. The continuous and discrete variables were analysed using Mann-Whitney/independent Student t-test. Results The median VAS scores in the postoperative period were significantly lower with RSB when compared with LA. Statistically significant differences in median VAS scores were noticed at one hour (P<0.001), four hours (P=0.001), eight hours (P<0.001), and 12 hours (P=0.014) at rest, and at one hour (P<0.001), four hours (P<0.001) and eight hours (P<0.001) during cough.The median morphine consumption was less with RSB (P<0.001). The time to first rescue analgesia was prolonged with RSB (P<0.001). The incidence of PONV was significantly lower with RSB (P=0.027). Conclusion Bilateral ultrasound-guided RSB provides extended postoperative analgesia at rest and cough for patients undergoing emergency laparotomy surgeries when compared with LA infiltration. There was a significant reduction in morphine consumption, incidence of PONV, and prolonged time to first rescue analgesia with RSB.

Analgesic efficacy of erector spinae plane block versus rectus sheath block in adults undergoing open para-umbilical hernia repair

Background: Rectus sheath block (RSB) is a popular technique for post-operative analgesia for patients undergoing abdominal surgeries with midline incisions. Ultrasound-guided erector spinae plane block (ESPB) is an interfacial plane block for the treatment of post-operative neuropathic pain. The aim of this study was to compare the analgesic efficacy of ESPB versus RSB in adult patients undergoing open para-umbilical hernia repair. Methods: This prospective randomized double-blinded study was carried out on seventy-four adult patients with ASA physical status I-II undergoing open paraumbilical hernia repair. Patients were divided into two equal groups: group I (ESPB): patients received bilateral ultrasound-guided ESPB using bupivacaine 0.25% (20 ml) on each side and group II (RSB): patients received bilateral ultrasound-guided RSB using bupivacaine 0.25% (20 ml) on each side. The following measurements was recorded: VAS score, intraoperative fentanyl consumption, the time to the first postoperative rescue analgesia administration, total dose of postoperative rescue analgesia (morphine) consumption, heart rate and mean arterial blood pressure.

Ultrasound-Guided Rectus Sheath Block as the Single Anaesthetic Technique for Umbilical Hernia Repair: A Report of 3 Cases.

In this study, we report 3 cases of ultrasound-guided rectus sheath block used for anaesthetic management of simple periumbilical surgery. We selected 3 patients based on the American Society of Anaesthesiology I-II and defect sizes known to be smaller than 4 cm without peritoneal involvement. We applied a rectus sheath block with 10 mL of 0.5% bupivacaine and 5 mL of 2% lidocaine bilaterally deposited in the space between rectus abdominis and posterior rectus sheath under real-time ultrasonography. Two of our patients tolerated surgery well with minimal sedoanalgesia; however, one of our patients needed dissociative anaesthesia to be compatible because the surgeon found out that the defect was bigger and adjacent to the peritoneum. Rectus sheath block is an underused technique that has the potential to be used as a sole anaesthetic technique in selected cases. So it would be wise to improve and consider rectus sheath block as a valuable tool when there is no better.