Liposomal Bupivacaine versus Ropivacaine with Dexamethasone in Rectus Sheath Block for Laparoscopic Gastrectomy: A...

The optimal analgesia regimen for patients undergoing laparoscopic gastrectomy is still unclear. This study evaluated the efficacy of ultrasound-guided rectus sheath block (RSB) with liposomal bupivacaine in providing sustained and effective analgesia to enhance recovery after laparoscopic gastrectomy.

The study population comprised 102 individuals who underwent randomization to receive a rectus sheath block with one of the following: Ropivacaine-Dexamethasone (RD group), Liposomal Bupivacaine (LB group), or Liposomal Bupivacaine-Dexamethasone (LBD group). The primary efficacy measure was defined as total opioid consumption (within 72 hour postoperative), converted to morphine milligram equivalents (MME). Secondary outcomes included pain scores at rest and during movement (within 72 hours postoperatively), QoR-15-based recovery quality, perioperative satisfaction, inflammatory biomarker levels (preoperative, 24h and 72h postoperatively), PACU/hospital stay duration, and adverse events.

The RD group had significantly higher total opioid consumption compared with the LB group and the LBD group. The LB group and the LBD group had significantly lower pain scores at rest and on movement at 12 h, 24 h, and 48 h after surgery, when compared with the RD group. The LB group and the LBD group had lower concentrations of Interleukin-1β (IL-1β) and interleukin-6 (IL-6) at 24 h compared with the RD group. In addition to reporting significantly better QoR-15 scores in the initial 48 hours, patients receiving liposomal bupivacaine (with or without dexamethasone) also experienced lower rates of PONV compared to the ropivacaine-dexamethasone cohort. Furthermore, there were no statistically significant differences between the three groups regarding length of post-anesthesia care unit stay, perioperative satisfaction, and length of hospital stay. There were no statistical differences between the LB group and the LBD group in all data. And the addition of dexamethasone to LBD provided no additional benefit over liposomal bupivacaine alone LB.

In conclusion, ultrasound-guided rectus sheath block with liposomal bupivacaine provided superior analgesia and reduced opioid consumption for up to 48 hours compared with a ropivacaine-dexamethasone regimen in patients undergoing laparoscopic gastrectomy. However, the addition of perineural dexamethasone to liposomal bupivacaine did not confer further analgesic benefit.

www.chictr.org.cn: Identifier: ChiCTR2500098338.