A Rectus Sheath Block in Open Hysterectomy

Introduction: Open gynecological surgery results in a large wound and severe postoperative pain, and adequate postoperative analgesia is necessary. Rectus sheath block (RSB) is used to block the sensory nerves of the anterior abdominal wall, thereby contributing to pain relief after lower abdominal surgeries. RSB provides effective perioperative analgesia and is related to lower perioperative opioid consumption and decreased opioid-related adverse effects. The prospective randomized study explores the effect of RSB on the evaluation of the postoperative pain following transabdominal open hysterectomy. Objective: The aim of this study is to evaluate the use of bilateral Ultrasound (US)-guided RSB on the evaluation of the postoperative pain. Patients and Methods: This prospective randomized study was carried out on 70 females, ASA I or II, presented for elective open hysterectomy under general anesthesia (GA) and randomly classified into 2 equal Groups 1 and 2, of 35 patients each; Group 1 (n=35) is the control Group, where the patients received standard general endotracheal anesthesia; patients in Group 2 (n=35), the tested Group, received RSB with 40 ml ropivacaine 0.375% (20ml each side) before surgery and standard endotracheal anesthesia. Mean arterial Blood pressure (MAP) and Heart rate (HR) were measured as baseline, after induction of general anesthesia (GA), every 15 min until completion of surgery, immediately after recovery, at 6h, 12h, and 24 h postoperatively. The primary outcome was the evaluation of the postoperative pain using the Visual Analogue Scale (VAS). Secondary outcomes included the measurement of the opioid consumption (intraoperative) and the amount of analgesics (postoperative) and some postoperative medical data as well. Results and conclusion: Postoperative VAS scores showed significantly high pain scores in patients in Group 1, VAS 0 with a mean value of 9.46 (9.14-9.78), VAS 1 mean value of 8.46 (7.49-8.97), and VAS 2 with a mean value of 7.03 (6.44-7.62). Comparatively, Group 2 recorded significantly low pain scores - VAS 0 with a mean value of 1.26 (-,65-1.87), VAS 1 had a mean value of 2.74 (2.18-3.3), and VAS 2 had a mean value of 3.75 (0.25-1.25), respectively. The use of RSB as an adjuvant to GA had reduced intraoperative opioid consumption, time to first bowel motility and discharge from bed, postoperative analgesic consumption and shorter post-anesthesia care unit discharge time. Furthermore, patients of the test Group 2 showed greater satisfaction.