Ultrasound-guided rectus-sheath block compared with thoracic epidural analgesia for major abdominal cancer surgeries with a midline incision

Abstract

Background The thoracic epidural analgesia (TEA) is considered as a standard technique for postoperative pain relief in major abdominal surgeries, but sometimes, it is contraindicated or complicated. Rectus-sheath block (RSB) bilaterally has developed recently to offer analgesia in these operations. This study was designed to evaluate the promising RSB as a suitable alternative to TEA in major operations for abdominal cancers through a midline incision. Patients and methods The current clinical trial that had been performed on American Society of Anesthesiologists I, II, and III patients underwent major operations for abdominal cancers through a midline incision, and randomly allocated into either the TEA group: received TEA with bupivacaine+fentanyl or RSB group: received RSB with bupivacaine+fentanyl bilaterally. The primary outcome was the cumulative intravenous (IV) fentanyl doses consumed through the postoperative 24 h. The secondary outcomes were the patients’ number who needed analgesia, the duration spent till the first analgesic request, visual analog score with rest and cough, and any complications related to either the block techniques or drugs. Results Cumulative IV fentanyl consumed and the titration doses of IV fentanyl during the postoperative 24 h, the time to the first request of fentanyl, number of patients who needed analgesia, and visual analog score with rest and cough at the time points of the study, all did not show any statistical significant difference between both groups. The RSB group recorded significant shorter time to ambulation compared with the TEA group. Sedation scores were comparable in both groups at all time points of the trial. Both groups were comparable regarding the incidence of fentanyl-associated side effects, time to passing flatus, and patient-satisfaction score. Conclusion RSB could be used as an efficient alternative to TEA, especially whenever the latter is contraindicated in patients subjected to major abdominal surgeries with midline incision.