A prospective, randomized, open label, controlled study investigating the efficiency and safety of 3 different methods of rectus sheath block analgesia following midline laparotomy

Abstract

Background:There is a controversy regarding the efficacy of rectus sheath block (RSB). The aim of the present study was to evaluate analgesic efficacy and safety of three different methods of RSB in postoperative pain management after midline laparotomy.Methods:A prospective, randomized, controlled, open-label clinical trial with 4 parallel groups was conducted in a tertiary care hospital in Finland. A total of 57 patients undergoing midline laparotomy were randomized to the control group (n = 12) or to 1 of the 3 active RSB analgesia groups: single-dose (n = 16), repeated-doses (n = 12), or continuous infusion (n = 17). Opioid consumption with iv-patient-controlled analgesia pump was recorded, and pain scores and patients’ satisfaction were surveyed on an 11-point numeric rating scale for the first 48 postoperative h. Plasma concentrations of oxycodone and levobupivacaine were analyzed. All adverse events during the hospital stay were recorded.Results:Oxycodone consumption was less during the first 12 h in the repeated-doses and in the continuous infusion groups (P = .07) and in numerical values up to 48 h in the repeated-doses group. Plasma oxycodone concentrations were similar in all 4 groups. Pain scores were lower in the repeated-doses group when coughing during the first 4 h (P = .048 vs. control group), and at rest on the first postoperative morning (P = .034 vs. the other 3 groups) and at 24 h (P = .006 vs. the single-dose group). All plasma concentrations of levobupivacaine were safe. The patients’ satisfaction was better in the repeated-doses group compared with the control group (P = .025). No serious or unexpected adverse events were reported.Conclusions:RSB analgesia with repeated-doses seems to have opioid sparing efficacy, and it may enhance pain relief and patients’ satisfaction after midline laparotomy.

Rectus Sheath Block Efficacy for Patients Who Underwent Emergency Midline Laparotomy at a Resource Limited Setting in Northcentral Ethiopia, 2019.

“…In line with our ndings, studies showed that BRSB is effective in reducing the severity of postoperative pain score, analgesics consumption and increases time to rst analgesic request [24][25][26][27]. While other studies failed to demonstrate BRSB effectiveness [28,29].…”

Continuous peripheral nerve blocks compared to thoracic epidurals or multimodal analgesia for midline laparotomy: a systematic review and meta-analysis

“…The intermittent dosing group had lower pain at rest at 12 hours; all other time points were not significantly different. [33] Similarly, Yassin 2017 found no differences in pain scores at any time point. [29] In terms of opioid consumption at 48 hours, Purdy 2018 found a reduction among both RSB groups compared to multimodal analgesia (Figure 2), whereas Yassin 2017 found opioid consumption to be significantly lower in the epidural group compared to the RSB group (Figure 3).…”

“…[26] Both Kadam et al (2013) and Wahba et al did not use opioids in their epidural solution. [36,46] Rectus Sheath Catheters Two studies involving rectus sheath block (RSB) catheters were included with one comparing to multimodal analgesia [33] and one comparing to epidural analgesia [29]. Purdy et al had three groups: RSB with intermittent dosing, RSB with continuous infusion, and control (opioid analgesia).…”

Transversus Abdominis Plane (TAP) and Rectus Sheath Blocks: a Technical Description and Evidence Review

“…A catheter may be placed at the time of block performance to extend the duration of analgesia. Catheter regimens vary, but intermittent bolus seems to be more efficacious than continuous infusion [5]. For example, 10 ml of 0.2% ropivacaine in each catheter every 4 h by a programmable pump is an efficacious and safe dose in adults.…”