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A Prospective Randomised Controlled Study to Compare Efficacy Between Ultrasound Guided Single Shot Rectus Sheath Block And Epidural For Postoperative Analgesia In Patients With Anterior Abdominal Wall Surgeries

Author: 
Dr. R. D. Patel, Dr. Abhishek B. Rathod and Dr. Nirav M. Kotak
Subject Area: 
Health Sciences
Abstract: 

Introduction: Ultrasound allows precise placement of local anaesthetic agents to the desired site. In our study, analgesic efficacy between ultrasound guided single shot rectus sheath block was compared with epidural analgesia in patients who have undergone surgeries with midline anterior abdominal incisions. Material And Methods: Hundred patients belonging to American society of anaesthesiologist (ASA) class I and II were included in our study, which is a randomised controlled study, and were divided in two groups, group A and group B. In group A, at the end of surgery, ultrasound guided single shot rectus sheath block was administered using 20 ml of 0.25% bupivacaine by supraumbilical approach on either side of midline, above the posterior rectus sheath. In group B, before induction of general anaesthesia, epidural catheter is placed in sitting position by midline approach and received 4ml of 0.125% bupivacaine through it for postoperative pain relief. Postoperative pain assessed using visual analogue scale (VAS) for first eight hours in immediate postoperative period. Analgesic efficacy was then evaluated by comparing VAS scores and need of rescue analgesia, among two techniques. All statistical calculations were done using computer programs Microsoft Excel 2007 (Microsoft Corporation, NY, USA) and SPSS (Statistical Package for the Social Science; SPSS Inc., Chicago, IL, USA) version 21. Results: Group A had better VAS scores in immediate postoperative period for first 30 minutes (mean VAS 3.20 in group A and 3.34 in group B), 30 to 60 minutes (mean VAS 2.72 in group A and 2.56 in group B), 60 to 90 minutes (mean VAS of 2.36 in group A and 2.74 in group B), 90 to 120 minutes (mean VAS of 2.02 in group A and 3.44 in group B), 2 to 4 hours (mean VAS of 1.92 in group A and 3.82 in group B), 4 to 6 hours (mean VAS of 1.92 in group A and 4.10 in group B), 6 to 8 hours (mean VAS 2.40 of in group A and 4.38 in group B) as compared to group B. In group A, out of 50 patients 6 patients which is 12% of the total group A population, received rescue analgesia, with 44 patients which is 88% of the total group A population did not receive any rescue analgesia. While in group B, out of 50 patients, 19 patients which is 38% of total group B population, received rescue analgesia, with 21 patients which is 62% of the total group B population did not receive any rescue analgesia (P value <0.01). Statistically significant difference has also been observed in postoperative pulse rate among group A and group B with P value of 0.026, indicating better pain relief among group A patients.With no complications noted in group A throughout study, while nausea and vomiting in two patients and hypotension among three patients of group B. Conclusion: Ultrasound guided rectus sheath block is a better analgesic modality than epidural analgesia in immediate postoperative period at some timeintervals requiring less amount of rescue nonopioid analgesia without any complications.

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