Preoperative versus Postoperative Rectus Sheath Block for Acute Postoperative Pain Relief after Laparoscopic Cholecystectomy: A Randomized Controlled Study

Hye-Won Jeong, Chan Sik Kim, Kyu Taek Choi, Sung-Moon Jeong, Doo-Hwan Kim, Jong-Hyuk Lee, Hye-Won Jeong, Chan Sik Kim, Kyu Taek Choi, Sung-Moon Jeong, Doo-Hwan Kim, Jong-Hyuk Lee

Abstract

Background: Pain after laparoscopic cholecystectomy (LC) is multifactorial and usually not effectively treated. Rectus sheath block (RSB) has been proven to reduce the pain from midline abdominal incision and laparoscopic surgery. We investigated the preemptive analgesic effect of RSB after LC.

Methods: In this prospective, randomized, single-center trial, 200 patients undergoing LC were randomized into preoperative RSB (pre-RSB) or postoperative RSB (post-RSB) group. An ultrasound-guided RSB was performed before skin incision in the pre-RSB group or after skin closure in the post-RSB group. The primary outcome was total rescue analgesic consumption at 24 h post-surgery. The secondary outcomes were cumulated rescue analgesic consumption and postoperative pain measured by numerical rating scale (NRS) at 0, 1, 2, 6, 9, 18, and 24 h post-surgery.

Results: Total rescue analgesic consumption at 24 h post-surgery was significantly lower in the pre-RSB group than in the post-RSB group (p = 0.020). The cumulated rescue analgesic consumption was significantly lower in the pre-RSB group than in the post-RSB group at 1 h (p = 0.023), 9 h (p = 0.020) and 18 h (p = 0.002) post-surgery. NRS was significantly lower in the pre-RSB group than in the post-RSB group at 0 h post-surgery (p = 0.023).

Conclusion: The pre-RSB reduced the analgesic requirements in patients undergoing LC compared with the post-RSB.

Keywords: laparoscopic cholecystectomy; preemptive analgesia; rectus sheath block.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study population. Abbreviations: ASA, American Society of Anesthesiologists; Pre-RSB, preoperative rectus sheath block; Post-RSB, postoperative rectus sheath block.
Figure 2
Figure 2
Cumulated rescue analgesic consumption during 24 h after surgery. Data are expressed as median (interquartile range). Horizontal lines, boxes, and error bars represent the median, interquartile range, and 10th and 90th percentile, respectively. * p < 0.05. Abbreviations: Pre-RSB, preoperative rectus sheath block; Post-RSB, postoperative rectus sheath block.
Figure 3
Figure 3
Postoperative pain scores (numerical rating scale 0 to 10) during 24 h after surgery. Data are expressed as median (interquartile range). * p < 0.05. Abbreviations: Pre-RSB, preoperative rectus sheath block; Post-RSB, postoperative rectus sheath block.

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