Comparitive Study Between Ultrasound Guided Rectus Sheath Block versus Local Wound Infiltration for Post-Operative Analgesia in Patients Undergoing Midline Exploratory Surgeries

Abstract Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress. respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Objective To assess the postoperative analgesic efficacy of Rectus Sheath Block (RSB) compared local wound infiltration after midline incision regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods All patients were informed with the procedure US guided RSB block and were trained to use the visual analogue scale (VAS). The study was conducted on 50 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective midline exploratory surgery. In Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 25 patients each: RSB block Group: received general anaesthesia and 20 ml of 0.25% bupivacaine on each side under ultrasound guidance. Local wound infiltration: received general anaesthesia and with 0.25% bupivacaine 20 ml at surgical site. Results The results of the study revealed that there is Patients receiving RSB block had significantly lower pain scores at rest for 12 h and on mobilization for 6 h after operation and decrease total need of analgesic in first 24 h post-operative compared with patients who received wound infiltration of local aneasthetic. Conclusion U/S-guided rectus sheath block is as effective analgesic technique as local infiltration of the surgical wound, with longer duration of action and pethidine -sparing effect during the postoperative period after midline exploratory surgeries.