Efficacy of ultrasound guided rectus sheath block on the postoperative quality of recovery in laparotomy surgeries; a randomized control trial

Abstract

Background: Recovery after surgery and anesthesia is a complex process therefore a variety of measurement tools have been developed such as QoR-40 and QoR-15 questionnaires to assess quality of recovery. We assessed the opioid sparing effect of rectus sheath (RS) blocks in improving the quality of recovery following midline laparotomy surgeries. Methodology: A randomized, controlled, open-labelled trial was conducted in the General surgery unit. Adult patients scheduled for elective midline laparotomy surgery under general anesthesia were included. Patients were divided into two groups: LA group and control group. Patients in the LA group received ultrasound guided, bilateral   rectus sheath block, while patients in the control group received patient-controlled analgesia for postoperative control. Results: Fifty-two patients were screened for eligibility. Median (range) aggregated global QoR-15 scores at 24 h were significantly greater in the LA group, indicating good quality of recovery compared with the control group; 107 (101-112) vs. 72 (68-74) with P < 0.001. In addition, pain profile was better in the LA group as 10 out of 24 (41%) Patients in the LA group required additional boluses of morphine during the 24-h period compared to 100% of patients in the control group (P < 0.001). Conclusion: Ultrasound guided rectus sheath block provides better quality of recovery profile in midline laparotomy   compared to opioids.  Abbreviations: ERAS - Enhanced Recovery After Surgery; LA - Local Anesthetic; RS - Rectus Sheath; RSB - Rectus Sheath Block; US - Ultrasound; QoR-15 - Quality of Recovery-15 Questionnaire; QoR-40 - Quality of Recovery-40 Questionnaire. Preregistration: The trial was registered on ClinicalTrials.gov (NCT05244746) after obtaining Ethical committee approval at Kasr AlAiny Cairo University (code:MS-202-2021). Keywords: Anesthesia Recovery Period; laparotomy; Nerve Block. Citation: Abougabal A, Hamed E, Mannaa A, Nabil N, Badry M. Efficacy of ultrasound guided rectus sheath block on the postoperative quality of recovery in laparotomy surgeries; a randomized control trial. Anaesth. pain intensive care 2024;28(3):489−494; DOI: 10.35975/apic.v28i3.2456 Received: May 12, 2023; Reviewed: January 17, 2024; Accepted: March 15, 2024