Application of incision-based precision multipoint rectus sheath block and bilateral rectus sheath block in...

This study evaluated whether the innovative multipoint incision-based rectus sheath block (IBRSB) tailored to surgical site and trauma level, could reduce opioid use and improve analgesia in laparoscopic-assisted colorectal surgery (LACS) compared to bilateral rectus sheath block (RSB).

A total of 72 patients undergoing LACS, with quantium consciousness index monitoring were randomized to receive either IBRSB or bilateral RSB using 40 ml of 0.4% ropivacaine (n = 36 for both). The primary outcome was intraoperative dosage of remifentanil.

Seventy patients completed the study, with 35 in each group. The IBRSB group had significantly lower remifentanil use (mean [SD]: 4.42 [2.01] vs 5.92 [2.53] μg/kg/h; 95% confidence intervals: -2.59 to -0.41; P = 0.008) and less postoperative sufentanil use via patient-controlled intravenous analgesia within 24 h. Intraoperative hemodynamics were more stable in the IBRSB group. Pain scores at rest and with movement similar between groups at all six postoperative time points. No block-related complications occurred.

Compared to bilateral RSB, IBRSB based on incision location and trauma severity significantly reduced intraoperative and postoperative opioid requirements, improved hemodynamic stability, and showed no increase in complications in patients undergoing LACS. Key messages What is already known on this topic: Laparoscopic surgery requires small midline incisions and multiple trocars, resulting in scattered wounds. An incision-based precision multipoint rectus sheath block (RSB), tailored to the surgical site and providing dual analgesia through local infiltration and nerve blockade, may be more suitable for laparoscopic-assisted colorectal surgery than bilateral RSB. What this study adds: The main finding was that ultrasound-guided incision-based precision multipoint RSB, compared to bilateral RSB, significantly reduced intraoperative and postoperative morphine equivalents in patients undergoing laparoscopic-assisted colorectal surgery. How this study might affect research, practice, or policy: The incision-based precision multipoint represents a safe and efficacious technique, which is recommended for routine implementation in patients subjected to laparoscopic-assisted colorectal surgery.