Comparison of Ultrasound Guided Bilateral Rectus Sheath Block versus Local Wound Infiltration for Post Operative Analgesia in Patients undergoing Laparotomy with Midline Incision

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. Aim of the Work The aim of this study is 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 The study was conducted on 56 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective midline expolaratory surgery. in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 28 patients each: Results Patients receiving RSB block had significantly lower pain scores at rest for 24 hr after operation and decrease total need of analgesic in first 24 h post operative compared with patients who received wound infiltration of local anaesthetic. Conclusion U/S-guided rectus sheath block is more effective analgesic technique than local infiltration of the surgical wound, with longer duration of action and pethidine -sparing effect during the postoperative period after midline exploratory surgeries.