Rectus sheath block for postoperative analgesia in patients with mesenteric vascular occlusion undergoing laparotomy: A randomized single-blinded study

Khaled Elbahrawy, Alaa El-Deeb, Khaled Elbahrawy, Alaa El-Deeb

Abstract

Background: Acute mesenteric ischemia is a life-threatening vascular emergency that requires early diagnosis, immediate anticoagulation, and intervention to restore mesenteric blood flow adequately.

Aims: To investigate the effect of rectus sheath block (RSB) for postoperative analgesia in patients with mesenteric vascular occlusion.

Settings and design: Forty patients with mesenteric vascular occlusion, American Society of Anesthesiologists physical status I or II or III, scheduled for laparotomy were enrolled in this study.

Subjects and methods: Patients were randomized into two groups; control group (C Group) and rectus block group (RB Group). In both groups, general anesthesia was induced fentanyl 1 μg/kg with sleeping dose of propofol and 0.15 mg/kg cisatracurium. Then, anesthesia was maintained with sevoflurane in oxygen 100%. In RB Group, under aseptic condition, RSB guided by ultrasound was performed. Surgery is then continued and intravenous fentanyl patient-controlled analgesia pump started. Postoperative pain, sedation, and opioid side effects were assessed.

Statistical analysis used: Statistical analysis was done using Statistical Package for Social Sciences (SPSS 19.0, Chicago, IL, USA).

Results: Patients in the RB Group consumed statistically significant less opioid in comparison to control group either intraoperatively or postoperatively. Mean pain scores were statistically significant less in RB Group than in the control group at 2, 4, and 6 h postoperatively. Sedation score, incidence of nausea and vomiting were statistically significant less in the RB Group in comparison to control group. More patients' satisfaction was reported in the RB Group.

Conclusions: Ultrasound-guided RSB resulted in postoperative reduction of pain scores and opioid consumption compared with general anesthesia alone. Moreover, RSB was associated with better patient satisfaction and less nausea and vomiting.

Keywords: Laparotomy; mesenteric vascular occlusion; rectus sheath block.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trails diagram of the study
Figure 2
Figure 2
Perioperative heart rate (beat/min). Data are mean ± standard deviation. *Significant when compared to Group C
Figure 3
Figure 3
Perioperative mean blood pressure (mmHg). Data are mean ± standard deviation. *Significant when compared to Group C

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