Comparison between Ultrasound Guided Bilateral Rectus Sheath Block and Local Wound Infiltration Using Bupivacaine for Post-Operative Analgesia in Patients Undergoing Midline Laparotomy

Objective: The purpose of this study was to compare the bilateral rectus sheath block and local wound infiltration using bupivacaine in patients undergoing mi2q c dline laparotomy for post-operative analgesia. Methodology: This was a double blind randomized controlled trial and carried out in the Department of Anesthesiology and Intensive Care Medicine in collaboration with Department of General Surgery of Chittagong Medical College Hospital, Chattogram, Bangladesh. A total of 160 patients undergoing midline laparotomy were taken as study sample by consecutive sampling. Then they were randomized to two groups. Group A: had received bilateral rectus sheath block with 0.25% bupivacaine 1mg/kg dose under ultrasonography guidance in between lateral aspect of rectus abdominis muscle and posterior layer of rectus sheath, Group B: had received local wound infiltration with 0.25% bupivacaine 1mg/kg dose at four points on each side of midline incision. After that post-operative information within the first 12 hours period in terms of total analgesic consumption, the first analgesic request time and VAS score and vital signs at a regular interval were recorded. Results: Rectus Sheath Block group had significantly reduced VAS score at 1.5 hour (p<0.001) and VAS at 2 hours (p<0.001) compared to local wound infiltration group. Statistically significant differences were observed among the groups regarding VAS score at 1 hour (p=0.021), 8 hours (p=0.016) and at 12 hours (p=0.001). Patients in Rectus Sheath Block group had reduced analgesic (inj. tramadol) consumption (61.43 ±12.45) mg compared to Local Wound Infiltration group (118.44±24.76) mg in 12 hours. The differences were statistically highly significant (p<0.001). First analgesic request time was significantly longer in Rectus Sheath Block group (8.16 ±0.37) hour compared to Local Wound Infiltration group (2.16 ±0.45) hour. The differences were statistically highly significant (p<0.001). Conclusion: Administration of bilateral rectus sheath block was found effective in providing postoperative analgesia with longer duration of action than local wound infiltration using Bupivacaine. Medicine Today 2026, Vol.38 (2): 200-203