ASSESSMENT OF POSTOPERATIVE ANALGESIC EFFECT OF RECTUS SHEATH BLOCK IN GYNECOLOGICAL LAPROSCOPIC SURGERY

Authors

  • Sobia Irum Patel Hospital Karachi-Pakistan
  • Samina Saleem Patel Hospital Karachi-Pakistan
  • Alia Bano Patel Hospital Karachi-Pakistan
  • Sadia Irum Patel Hospital Karachi-Pakistan
  • Kaneez Fatima Patel Hospital Karachi-Pakistan

DOI:

https://doi.org/10.55519/JAMC-03-13719

Keywords:

Laparoscopy, pain, bupivacaine, BRSB

Abstract

Background: Gynecological laparoscopic surgery is a minimally invasive surgical technique that can cause pain and discomfort in the postoperative period. To manage this pain, various analgesic techniques have been employed, including rectus sheath block (RSB). Bupivacaine is a long-acting local anesthetic that has been used in bilateral rectus sheath block (BRSB) for postoperative pain relief after laparoscopic surgery. The objective of this study is to assess the impact of bupivacaine’s bilateral rectus sheath block (BRSB) on post-laparoscopic pain relief with its intraperitoneal (IP) administration. Methods: This prospective randomized, double-blind, clinical trial was done at the department of obstetrics and gynaecology Patel hospital Karachi, from September 2022 to February 2023. All the adult female patients aged 18 years or older undergoing elective gynecological laparoscopic surgery and willing to receive RSB as a postoperative analgesic technique were included. After taking informed consent, the patients were randomly allocated into two groups. In group I, BRSB was performed with 25 mg of bupivacaine and in group II was given 25 mg of bupivacaine intraperitoneal. Postoperative pain was assessed by visual analog pain score (VAS) at 1st, 6th, 10the and 24the hours postoperatively. All the information was collected via study proformas. Results: The study comprises 60 patients who underwent gynecological laparoscopic surgeries, with group I having a mean age of 38.10+11.19 years and an average BMI of 27.07+5.15 kg/m2, and group II having a mean age of 41.36+11.18 years and an average BMI of 27.51+4.22 kg/m2. Average (VAS) was significantly lower in group I compared to group II at 1st, 6th, 10th, and 24th hour, with a statistically significant p-value of 0.001. The average duration of surgery was not statistically significant in both groups, as an average duration in group I was 32.14+12.20 minutes and in group II was 31.0+19.21 minutes. Conclusion:  The use of bupivacaine in a bilateral rectus sheath block (BRSB) with was observed to be more effective for post-laparoscopic pain relief compared to 25 mg of bupivacaine intraperitoneal administration.

References

Levy L, Tsaltas J. Recent advances in benign gynecological laparoscopic surgery. Fac Rev 2021;10:60.

Dior UP, Kathurusinghe S, Cheng C, Reddington C, Daley AJ, Ang C, et al. Effect of surgical skin antisepsis on surgical site infections in patients undergoing gynecological laparoscopic surgery: a double-blind randomized clinical trial. JAMA Surg 2020;155(9):807–15.

Sao CH, Chan-Tiopianco M, Chung KC, Chen YJ, Horng HC, Lee WL, et al. Pain after laparoscopic surgery: Focus on shoulder-tip pain after gynecological laparoscopic surgery. J Chin Med Assoc 2019;82(11):819–26.

Lee J, Park C, Kim J, Ki Y, Cha SH, Kim JY. Effect of low-pressure pulmonary recruitment maneuver on postlaparoscopic shoulder pain: randomized controlled trial. J Minim Invasive Gynecol 2020;27(1):173–7.

Kaloo P, Armstrong S, Kaloo C, Jordan V. Interventions to reduce shoulder pain following gynaecological laparoscopic procedures. Cochrance Database Syst Rev 2019;1(1):CD011101.

Allene MD. Assessment of the analgesic effectiveness of bilateral rectus sheath block as postoperative analgesia for midline laparotomy: prospective observational cohort study. Int J Surg Open 2020;24:166–9.

Malchow R, Jaeger L, Lam H. Rectus sheath catheters for continuous analgesia after laparotomy—without postoperative opioid use. Pain Med 2011;12(7):1124–9.

Kaufman E, Epstein JB, Gorsky M, Jackson DL, Kadari A. Preemptive analgesia and local anesthesia as a supplement to general anesthesia: a review. Anesth Prog 2005;52(1):29–38.

Ohnesorge H, Günther V, Grünewald M, Maass N, Alkatout İ. Postoperative pain management in obstetrics and gynecology. Journal of the Turkish German Gynecological Association. 2020;21(4):287.

Salem WT, Alsamahy KA, Ibrahim WA, Alsaed AS, Salaheldin MM. Effect of Adding Dexmedetomidine to Bupivacaine in ultrasound guided rectus sheath block: a randomized controlled double-blinded study. Open Anesth J 2019;13:25–30.

Teshome D, Hunie M, Essa K, Girma S, Fenta E. Rectus sheath block and emergency midline laparotomy at a hospital in Ethiopia: A prospective observational study. Ann Med Surg 2021;68:102572.

Kuldeep A, Gehlot R, Sharma M, Jangir K, Raiger LK. Comparison of analgesic efficacy of ropivacaine and bupivacaine in rectus sheath block for midline abdominal surgeries. Indian J Clin Anaesth 2020;7(2):219–25.

Azemati S, Khosravi MB. An assessment of the value of rectus sheath block for postlaparoscopic pain in gynecologic surgery. J Minim Invasive Gynecol 2005;12(1):12–5.

Cho S, Kim YJ, Jeong K, Moon HS. Ultrasound-guided bilateral rectus sheath block reduces early postoperative pain after laparoscopic gynecologic surgery: a randomized study. J Anesth 2018;32(2):189–97.

Mowafi MM, Elsenity MA, Elbeialy MA. Surgical transversus abdominis plane block versus surgical rectus sheath block for postoperative pain control in morbid obese patients undergoing major gynaecological surgery: a prospective, randomized, blinded study. Ain-Shams J Anesthesiol 2022;14(1):1–9.

Choi BJ, Choi SG, Ryeon O, Kwon W. A study of the analgesic efficacy of rectus sheath block in single-port total laparoscopic hysterectomy: a randomized controlled study. J Int Med Res 2022;50(10):03000605221133061.

Hamid HK, Ahmed AY, Alhamo MA, Davis GN. Efficacy and safety profile of rectus sheath block in adult laparoscopic surgery: a meta-analysis. J Surg Res 2021;261:10–7.

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Published

2024-09-08