Key result
Ultrasound-guided bilateral rectus sheath block significantly reduced postoperative pain scores at rest and during cough compared to local anaesthetic infiltration in patients undergoing emergency midline laparotomy.
Why the study?
Rectus sheath block is increasingly utilised in multimodal analgesia for laparotomy, but its analgesic efficacy compared with local anaesthetic infiltration needed evaluation.
Does ultrasound-guided bilateral rectus sheath block improve postoperative analgesia and reduce morphine consumption compared to local anaesthetic infiltration in patients undergoing emergency midline laparotomy?
RCT (n=100)
Observer-blinded
Computer-generated random number table of varying block sizes
No
Does ultrasound-guided bilateral rectus sheath block improve postoperative analgesia and reduce morphine consumption compared to local anaesthetic infiltration in patients undergoing emergency midline laparotomy?
Effect estimate: Decline in median VAS score by 1 at rest and 2 at cough
p-value: p=<0.001
Ultrasound-guided bilateral rectus sheath block provides superior postoperative analgesia, reduces morphine consumption, and decreases postoperative nausea and vomiting compared to local anesthetic infiltration in emergency laparotomy.
Supports RSB over LA infiltration for post-laparotomy analgesia; extends RCT evidence to emergency midline cases.
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.
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LaguduvaH et al. (2022) conducted an RCT in Emergency midline laparotomy surgeries (n=100). Ultrasound-guided bilateral rectus sheath block vs. Local anaesthetic infiltration was evaluated on Visual analogue scale (VAS) scores at rest and cough in the postoperative period (Decline in median VAS score by 1 at rest and 2 at cough, p=<0.001). Ultrasound-guided bilateral rectus sheath block significantly reduced postoperative pain scores at rest and during cough compared to local anaesthetic infiltration in patients undergoing emergency midline laparotomy.
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