Bilateral Rectus Sheath Block with Continuous Bupivacaine Infusions After Elective Open Gastrectomy : A Randomized Controlled Trial
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2024-12
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Abstract
Background and Objectives: Multimodal analgesia has been shown to be effective in facilitating early postoperative gastrointestinal function and rehabilitation in patients undergoing open gastrectomy. We conducted a clinical trial to investigate the effectiveness of bilateral rectus sheath block (RSB) with continuous bupivacaine infusion in comparison with placebo following elective open gastrectomy. Materials and Methods: Patients indicated for elective open gastrectomy were screened, enrolled, and randomised between October 2021 and September 2023. The patients were randomised to either Group A (intervention—continuous bupivacaine) or Group B (control—NaCl saline). The primary outcome measures were the quantity of an opioid analgesic administered during the initial 72 h post-surgery and the level of postoperative pain as indicated by the visual analogue scale (VAS). Mann–Whitney U test was used for quantitative analysis while Pearson Chi-square was used for categorical variables. Results: A total of 60 patients completed the trial, with 30 patients in each of the two groups. Patients in Group A reported lower median VAS pain scores at all observed time points following surgery (p < 0.001). No patient in Group A required rescue opioid analgesia, although non-steroidal anti-inflammatory drugs were necessary during the initial 12 h postoperatively. Clinically, Group A patients had a significantly shorter time to first gas (p = 0.001), a shorter time to first bowel movement (p < 0.001), a shorter time to first out-of-bed activity (p < 0.001), and a shorter overall hospitalisation duration (p < 0.001) compared to Group B patients. Conclusions: Bilateral RSB with continuous bupivacaine infusion is effective in managing pain and can reduce the use of opioid analgesics in the postoperative period. Furthermore, it promotes early recovery, and a shorter hospital stay.
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Publisher Copyright: © 2024 by the authors.
Keywords
bupivacaine infusion, enhanced recovery, laparotomic gastrectomy, multimodal analgesia, rectus sheath block, 3.2 Clinical medicine, 1.1. Scientific article indexed in Web of Science and/or Scopus database, General Medicine
Citation
Opincāns, J, Ivanovs, I, Miscuks, A, Pāvulāns, J, Mārtinsone, K D, Rudzats, A, Kecbaja, Z, Gutnikovs, O & Kaminskis, A 2024, 'Bilateral Rectus Sheath Block with Continuous Bupivacaine Infusions After Elective Open Gastrectomy : A Randomized Controlled Trial', Medicina (Lithuania), vol. 60, no. 12, 1992. https://doi.org/10.3390/medicina60121992