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A Rectus Sheath Block in Open Hysterectomy.

Goran Mitreski1,2, Nevenka Laban Guceva2, Valentina Mitreska3

  • 11PHI Specialized Hospital for Gynecology and Obstetrics "Mother Тheresa" Skopje, RN Macedonia.

Prilozi (Makedonska Akademija Na Naukite I Umetnostite. Oddelenie Za Medicinski Nauki)
|March 21, 2026
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Summary

Ultrasound-guided rectus sheath block (RSB) significantly reduced postoperative pain and opioid consumption in patients undergoing open hysterectomy. This technique offers improved patient satisfaction and faster recovery compared to standard anesthesia.

Keywords:
Rectus Sheath Block (RSB)Visual Analogue Scale (VAS)open hysterectomypostoperative pain

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Area of Science:

  • Anesthesiology
  • Surgical Pain Management
  • Regional Anesthesia

Background:

  • Open gynecological surgeries like hysterectomy cause significant postoperative pain, necessitating effective analgesia.
  • Rectus sheath block (RSB) targets anterior abdominal wall sensory nerves, providing pain relief for lower abdominal surgeries.
  • RSB is associated with reduced opioid use and fewer adverse effects during the perioperative period.

Purpose of the Study:

  • To evaluate the efficacy of bilateral Ultrasound (US)-guided RSB in managing postoperative pain after transabdominal open hysterectomy.

Main Methods:

  • A prospective randomized study involving 70 female patients undergoing elective open hysterectomy.
  • Patients were divided into two groups: a control group (standard general anesthesia) and a test group (US-guided RSB with ropivacaine plus standard general anesthesia).
  • Postoperative pain was assessed using the Visual Analogue Scale (VAS), with secondary outcomes including opioid consumption and recovery metrics.

Main Results:

  • The RSB group (Group 2) demonstrated significantly lower VAS pain scores at all measured time points compared to the control group (Group 1).
  • Intraoperative opioid consumption, time to first bowel motility, and time to discharge from bed were reduced in the RSB group.
  • Patients receiving RSB experienced shorter post-anesthesia care unit discharge times and reported higher satisfaction.

Conclusions:

  • Bilateral Ultrasound-guided RSB is an effective analgesic technique for open hysterectomy.
  • RSB improves pain control, reduces opioid requirements, and enhances recovery and patient satisfaction following open abdominal gynecological surgery.