To Compare the Analgesic Efficacy of Ultrasound-Guided Rectus Sheath Block With Conventional Analgesia on Postoperative Analgesic Consumption in Abdominal Surgeries With Midline Incision-a Randomized Comparative Study

Background: Postoperative pain following abdominal surgery with a midline incision is typically severe and significantlyincreases postoperative opioid consumption. Ultrasound-guided rectus sheath block (RSB) delivers localized somaticanalgesia across the anterior abdominal wall, potentially reducing the reliance on systemic postoperative analgesics.Materials and Methods: This randomized comparative study evaluated 70 patients aged 18–60 years who underwentabdominal surgeries involving a midline incision. Participants were randomly assigned to two equal parallel groups (n = 35each). Group A received general anaesthesia combined with an ultrasound guided bilateral rectus sheath block using 20 mLof 0.25% bupivacaine per side. Group B received general anaesthesia followed by conventional standard-of-care systemicanalgesia. Postoperative pain intensity was monitored using a Numerical Rating Scale (NRS) at baseline (0 minutes) and at30 minutes, 1 hour, 4 hours, 8 hours, 12 hours, 16 hours, and 24 hours post-surgery. Key outcome measures included time tofirst rescue analgesia, total 24-hour tramadol consumption, intraoperative fentanyl requirements, hemodynamic stability, andthe incidence of adverse effects. Results: The time to first rescue analgesia was significantly longer in Group A compared toGroup B (5.56 ± 1.56 hours vs. 1.97 ± 0.79 hours; p < 0.001). Total 24-hour tramadol consumption was also significantlylower in Group A (111.43 ± 32.28 mg vs. 126.43 ± 27.08 mg; p = 0.039). Similarly, intraoperative fentanyl requirementswere notably reduced in Group A (104.29 ± 14.20 mcg vs. 123.57 ± 33.73 mcg; p = 0.0027). Furthermore, postoperativeNRS pain scores were significantly lower in Group A at all evaluated time points, with no significant differences inhemodynamic parameters or adverse event rates between the two cohorts. Conclusion: Ultrasound-guided rectus sheathblock provides postoperative analgesia and reduces both perioperative opioid without inducing hemodynamic instability orincreasing adverse event rates.