Abstract
Background
Midline laparotomy is associated with severe postoperative pain. Literature showed controversial results regarding the efficacy of the rectus sheath block.
Methods
This is a prospective cohort study that recruits 30 patients in the rectus sheath block (RSB) group and 30 patients in the multimodal analgesia (MMA) group who underwent emergency midline laparotomy. The RSB was performed by an experienced anesthetist using a land-mark technique. Independent t-test and Mann-Whitney-U test were used for numeric data while Chi-Square or Fisher exact test was used for categorical variables. P-values < 0.05 were considered as statistically significant.
Results
The numeric rating scale score at the recovery was significantly reduced in an RSB group with a p-value of 0.039. Postoperative numeric rating scale scores at 3rd, 6th, 12th, and 24th hours were statistically significantly lower in the RSB group. Postoperative tramadol consumption in 24 h was significantly lower with a p-value of 0.0001 for the rectus sheath group.
Conclusions
For midline laparotomy, adding a bilateral rectus sheath block at the end of the operation might be an effective postoperative analgesia option.
Keywords: Rectus sheath block, Laparotomy, Pain
Highlights
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BRSB might reduce a postoperative pain severity score.
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Postoperative analgesic consumption might be reduced in BRSB group.
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BRSB could decrease the incidence of postoperative Nausea and vomiting.
1. Introduction
The International Association for the Study of Pain defined pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage [1]. Laparotomies that necessitate midline incisions were commonly accompanied by postoperative pain, typically associated with neuroendocrine stress response [2,3]. Postoperative analgesia enhances early mobilization and decreases the incidence of postoperative pneumonia and deep venous thrombosis [4,5].
Administration of multimodal analgesics could limit the excessive use of systemic opioid analgesia and its side effects [[4], [5], [6], [7], [8]]. Good postoperative pain management improves the wound healing process [9]. Postoperative pain management minimizes the feeling of discomfort and makes the treatment more economic, however, there is no ideal method available for this [10,11].
Schleich firstly described RSB in 1899 aiming at the deposition of local anesthetic (LA) in the virtual space between the posterior wall of the rectus abdominis muscle and its sheath [12]. The anesthetic injected into this space is proposed to spread freely up and down and to block the anterior branches of the thoracoabdominal nerves before they leave the rectus sheath [[13], [14], [15]].
The central portion of the anterior abdominal wall is innervated by the ventral branches of the lower thoracic nerves (T6-T12); these ventral branches lie between the rectus abdominis muscle (deep) and the posterior rectus sheath (ventral) and enter the rectus muscle near the midline [[16], [17], [18], [19]]. The RSB can be performed using a blind technique when there is no access to ultrasound in a resource-limited setting like ours [17,18,[20], [21], [22]]. This study aims to assess the postoperative analgesic efficacy of the rectus sheath block for emergency midline laparotomy. In this study, we hypothesized that there is a difference in the time to first analgesic request, postoperative pain severity score (NRS), and the total post-operative analgesic consumption within 24 h between the multimodal analgesia group and rectus sheath block group.
2. Methods
2.1. Study setting, design, period, and population
A Hospital-based prospective cohort study was conducted at Xx Hospital, in North-central Ethiopia from February 01 to March 30, 2019. The Hospital gives medical, surgical, pediatrics, gynecologic, and obstetrics services. Patients who have undergone emergency midline laparotomy at the study setting were the source population while selected patients who underwent emergency midline laparotomy during the study period were the study population. Patients with a psychiatric diagnosis, age less than 18, and patients who were chronic opioid users were excluded. This study is reported in line with STROCCS criteria [23]. It is registered at www.researchregistry.com with Research Registry UIN: researchregistry5844 and available at https://www.researchregistry.com/browse-the-registry#home/registrationdetails/5f1dfd81ebfc400016eeb0bd/.
Ethical permission was obtained from a research ethics committee of Debre Tabor University college of Health sciences. The permission was taken from Xx Hospital. Informed consent was secured from all study participants after telling them the aim, benefit, and risk of participating in the study.
2.2. Sample size determination
The sample size was determined by using a statistical power of 80% (β = 0.2) and a statistical significance of 0.05 and means and standard deviations for each outcome variable of the groups were taken from a previous study [24]. The ratio of treatment to control (1:1). The sample size was calculated by constituting the values into G-power for all outcome variables.
Visual Analogue Scale score in RSB group: μ1 = 1.16, SD1 = 1.20, the calculated sample size for RSB group = 31; Visual Analogue Scale score in MMA group: μ2 = 1.83, SD2 = 0.74, the calculated sample size for MMA group = 31. By adding 5% contingency the total required patients were 66.
2.3. Sampling techniques and procedures
A systematic random sampling technique was used to select study participants. The sampling interval k was determined to be approximately 2 using the formula: k = N/n (95/66); where n = total sample size, N = population per two months. Each participant had about 50% equal probability of being included in the study. A schedule list of midline laparotomy was used as a sampling frame and the first random start was determined by a simple lottery method then the skipping interval was used for the rest of the study participants till the sample size was completed. The selected study participants were allocated to either of the group based on what they had been given for postoperative pain management plan (MMA or RSB).
2.4. Operational definition
Midline Laparotomy: It is an abdominal cavity operation through a midline incision of the abdomen, from xiphisternum to symphysis pubis.
NRS: This is a valid pain intensity assessment tool that involves asking a patient to rate his or her pain from 0 to 10 (11point scale) with the understanding that 0 is equal to no pain and 10 equals to the worst possible pain. NRS is reliable in a rural population irrespective of literacy status [25].
Baseline vital signs: Vital signs (Diastolic blood pressure, Systolic blood pressure, and Heart rate) recorded on the anesthetic monitoring before the induction of anesthesia.
2.5. Data collection procedures and tools
Data was collected by using a prepared questionnaire starting from intraoperative to 24 h postoperatively. The RSB was performed by an experienced anesthetist using a land-mark technique [26,27]. The patient lying supine, a point is identified 3 cm from midline then passing a short-beveled 5 cm needle through the anterior rectus sheath (“pop” felt) and through the rectus abdominis muscle and the needle is advanced further until a firm resistance was felt. After negative aspiration for blood, 20 ml of 0.25% bupivacaine was deposited on the posterior wall of the rectus sheath. The procedure was repeated on the opposite side of the midline (Fig. 1).
Fig. 1.
Rectus sheath block, with depiction of needle position and location of local anesthetic injection.
The severity of pain by using NRS [25], time for the first analgesic request (in hours), 24 h analgesics consumption and incidence of postoperative nausea and vomiting were collected by two anesthetists. Data was gathered at five-time points: at 0 (immediately at recovery), 3, 6, 12, and 24 h postoperatively. Postoperative pain was managed by diclofenac and/or tramadol based on patient request and/or pain severity score (NRS) greater than three.
2.6. Data quality control
Before the actual data collection pretest was done on 10% of the sample size to see the effectiveness of the data collecting tool and questionnaire. Collected data were checked for completeness, accuracy, and clarity.
2.7. Statistical analysis
Data were checked manually for completeness, coded, and entered into the SPSS version 23 computer program. Descriptive statistics were used to summarize data. Chi-square or Fisher exact test was used for discrete variables and a student's t-test was used for comparing numerical variables of normally distributed data or Mann-Whitney-U test was used for skewed data. A P-value of less than 0.05 was considered statistically significant.
3. Results
3.1. Demographic and perioperative characteristics
Data were collected from sixty patients. Six patients from the multimodal analgesia group and rectus sheath block group were lost to follow up. Demographic data such as age, sex, and ASA status were comparable between the multimodal analgesia group and rectus sheath block group (Table 1).
Table 1.
Demographic characteristics of patients who underwent emergency midline laparotomy at Xx Hospital.
| Variables | RSB group (n = 30) | MMA group (n = 30) |
|---|---|---|
| Age (mean ± Standard deviation) | 45 ± 13 | 44 ± 15 |
| Sex (F/M) | 16/14 | 17/13 |
| ASA status, n (%) | ||
| ASA 1 | 21(70%) | 20(67%) |
| ASA 2 | 9(30%) | 10(33) |
Hint M: male; F: Female; ASA: American Society of Anesthesiology.
3.2. Preoperative vital signs
Preoperative vital signs expressed in the median and interquartile range were comparable between two the multimodal analgesia group and rectus sheath block group (Table 2).
Table 2.
Preoperative vital signs of patients who underwent emergency midline laparotomy at Xx Hospital.
| Variable | RSB group (n = 30) | MMA group (n = 30) | P-value |
|---|---|---|---|
| Base line heart rate | 80(69.7–83.2) | 80(68–90) | 1.000 |
| Base line systolic blood pressure | 121(110–130) | 124(111–135) | 0.605 |
| Base line diastolic blood pressure | 75(70–80) | 76(70–80) | 0.429 |
3.3. Perioperative characteristics of patients
Types of induction agents, muscle relaxants, pre-medications, analgesics, and diagnosis were expressed in frequency and percentage (Table 3).
Table 3.
The intraoperative characteristics of patients who underwent emergency midline laparotomy at Xx Hospital.
| Variables | RSB group (n = 30) | MMA group (n = 30) |
|---|---|---|
| Types of induction agent | ||
| Ketamine | 19(32%) | 17(28%) |
| Propofol | 5(8%) | 6(10%) |
| Ketofol | 6(10%) | 7(12%) |
| Diagnosis | ||
| Sigmoid volvulus | 8(14%) | 7(12%) |
| Blunt abdominal injury | 6(10%) | 7(12%) |
| Perforated appendicitis | 8(13%) | 9(15%) |
| Small bowel obstruction | 5(8%) | 5(8%) |
| Other | 3(5%) | 2(4%) |
| Analgesia | ||
| Tramadol | 15(25%) | 14(24%) |
| Pethidine | 9(15%) | 11(18%) |
| Diclofenac | 6(10%) | 5(8%) |
| Types of induction | ||
| Suxamethonium | 23(38%) | 22(37%) |
| Vecuronium | 7(12%) | 8(13%) |
3.4. Postoperative vital signs
The postoperative vital signs were taken immediately at the arrival of the recovery room, 6th, 12th, and 24th hours postoperatively were statistically significant differences between the multimodal analgesia group and rectus sheath block group (Table 4).
Table 4.
Postoperative vital signs expressed in median (interquartile range) of patients who underwent emergency midline laparotomy at Xx Hospital.
| Variable | RSB group (n = 30) | MMA group (n = 30) | P-value |
|---|---|---|---|
| SBP immediately at arrival of recovery room | 124(119.5–129) | 128(121.5–129) | 0.009** |
| DBP immediately at arrival of recovery room | 74(70–82.5) | 70(70–80) | 0.439 |
| PR immediately at arrival of recovery room | 89(83.3–92) | 82(70–88.5) | 0.789 |
| SBP at 3rd hour postoperative | 120(120–124) | 120(119.5–128) | 0.288 |
| DBP at 3rd hour postoperatively | 72(70–80) | 70(70–78.5) | 1.00 |
| PR at 3rd hour postoperatively | 80(78–85) | 84.5(82–98) | 0.111 |
| SBP 6th hour postoperatively | 116(110–124) | 120(115–128.5) | 0.010** |
| DBP 6th hour postoperatively | 77(70–80) | 73.5(70–78.5) | 0.796 |
| PR 6th hour postoperatively | 81(77.5–82) | 82(80–88.8) | 0.438 |
| SBP at 12th hour postoperatively | 110(100–118) | 120(115-127 | 0.0001** |
| DBP at 12th hour postoperatively | 70(70–75) | 75(70–80) | 0.020** |
| PR at 12th hour postoperatively | 80(71–80) | 75(70–80) | 0.110 |
| SBP at 24th hour post operatively | 115.5(100–120) | 122.5(119.5–129) | 0.006** |
| DBP at 24th hour post operatively | 80(70–80) | 79(69.8–80.3) | 0.160 |
| PR at 24th hour post operatively | 80.5(74–85) | 80(75–89) | 0.796 |
| First analgesic request (in hours) | 8(7–9) | 2(1–2.3) | 0.001** |
Hint** = statistically significant; DBP: Diastolic Blood Pressure; PR: Pulse Rate; SBP: Systolic Blood Pressure.
3.5. Comparison of postoperative pain severity by numeric pain rating scale
The median NRS score was lower in the RSB group at 0 (immediately at the arrival of recovery room), 3rd, 6th, and 12th hours postoperatively (p-values < 0.05) (Table 5).
Table 5.
The median (IQR) Numeric Rating Scale score between the multimodal analgesia group and rectus sheath block group of patients who underwent emergency midline laparotomy at Xx Hospital.
| Variable | RSB group (n = 30) | MMA group (n = 30) | P-value |
|---|---|---|---|
| NRS immediately at the arrival of recovery room | 3(3–4) | 4.5(3–4.5) | 0.039** |
| NRS at 3rd hour post operatively | 3(3–4) | 5(4–6) | 0.0001** |
| NRS at 6th hour post operatively | 3(3–4) | 4(4–5) | 0.030** |
| NRS at 12th hour post operatively | 3(3–5) | 4(4–6) | 0.041** |
| NRS at 24th hour postoperatively | 3(3–4) | 5(3.8–6) | 0.0001** |
Hint: ** = statistically significant, NRS: Numeric Rating Scale.
3.6. Comparison of total analgesics consumption between the multimodal analgesia group and rectus sheath block group
The tramadol consumption in milligram was 25(25–50) and 150(100–200) while diclofenac consumption in milligram was 0(0–75) and 75(75-75) in rectus sheath block and multi-modal analgesia group with p-values of 0.0001 and 0.013 in the first 24 h postoperatively.
3.7. Incidence of postoperative nausea and vomiting
The incidence of postoperative nausea and vomiting over 24 h decreased in the RSB group. As indicated by the proportion of postoperative nausea and vomiting in the RSB group was (36.7%) compared to the control group (50%) with a p-value of 0.0001.
4. Discussion
The RSB was performed by an experienced anesthetist using a land-mark technique [27]. After confirming the potential place and a negative aspiration for blood, 20 ml of 0.25% bupivacaine was deposited on the posterior wall of the rectus sheath bilaterally. In this study, the severity of pain by using NRS, time to first analgesic request and 24 h analgesics consumption were the primary outcome variables while the incidence of postoperative nausea and vomiting was a secondary outcome variable. This study demonstrates that RSB in patients undergoing emergency midline laparotomy resulted in statistically significant lower pain scores when compared with a multi-modal analgesia group immediately at the recovery room. The pain severity score in NRS was also lower in the RSB group at 3rd, 6th, 12th hours postoperatively. Twenty-four hours of analgesics consumption were reduced in the RSB group. This study found that the incidence of postoperative nausea and vomiting in the RSB group was lower when compared to the MMA group over 24 h postoperatively.
In line with our findings, studies done by Purdy M. et al., Bashandy G. et al., Ibrahim M. et al., Smith B. et al. and Allene MD showed that RSB is effective in reducing the severity of postoperative pain score, analgesics consumption and increases time to first analgesic request [[28], [29], [30], [31], [32]]. While other studies failed to demonstrate RSB effectiveness [22,33].
Though there was a proportional difference among the multimodal analgesia group and rectus sheath block group for the incidence of postoperative nausea and vomiting, there was no statistically significant difference between the multimodal analgesia group and rectus sheath block group. Contrarily, the studies done by allene MD and Elbahrawy ED showed a statistically significant difference between two groups in the incidence of nausea and/or vomiting within 24hr between the groups [32,34].
Currently, the important factor that could affect the duration and recovery from postoperative ileus might be decreasing the dose of narcotics [35]. The limitation of this study could be the study design was not a randomized controlled trial.
5. Conclusions
The bilateral rectus sheath block might be an effective analgesic option for midline laparotomy. This block is effective in reducing the first 24 h of postoperative analgesic consumption. The incidence of postoperative nausea and vomiting over 24 h decreased in the RSB group as compared to the MMA group.
Funding
No.
Conflict of interest
The authors declare that there is no conflict of interests.
Ethics approval and consent to participate
An ethical permission was obtained from a research ethics committee of Debre Tabor University college of Health sciences. The permission was taken from Debre Tabor Comprehensive Specialized Hospital. Informed consent was secured from all study participants after telling them the aim, benefit and risk of participating in the study. The anonymity of the patient's information was kept confidential.
Sources of funding
Nothing to declare
Authors’ contributions
All authors equally participated in write up of the proposal, data entry, data analysis and final manuscript preparation. The final manuscript is read and approved by all authors.
Consent
Informed consent was taken from a parent of the study participants after telling them the aim of the study, benefit, harm of participating in the study, and they have been told as they can withdraw from the study at any step if they feel so.
Registration of Research Studies
Name of the registry: http://www.researchregistry.com.
Unique Identifying number or registration ID: researchregistry5844.
Hyperlink to your specific registration (must be publicly accessible and will be checked): https://www.researchregistry.com/browse-the registry#home/registrationdetails/5fa9102a5030b800153ebb76/.
Guarantor
Mr. Diriba Teshome.
Availability of data and materials
Data and materials will be shared upon reasonable request.
Provenance and peer review
Not commissioned, externally peer-reviewed.
Declaration of competing interest
Nothing to declare.
Acknowledgements
We would like to acknowledge Debre Tabor University, College of health sciences ethical review committee for giving us ethical clearance. Our thank also goes to Debre Tabor Comprehensive Specialized Referral Hospital staffs and Patients for their co-operation during data collection.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.amsu.2021.102572.
Abbreviations/acronyms
- ASA
American Society of Anesthesiology
- RSB
Rectus Sheath Block
- LA
Local Anesthesia
- NRS
Numeric Rating Scale
- IQR
Inter Quartile Range.
Funding
Nothing to declare.
Ethical approval
Ethical clearance was obtained from Debre Tabor University, college of health sciences ethical clearance committee.
Consent
Informed consent was taken from a parent of the study participants after telling them the aim of the study, benefit, harm of participating in the study, and they have been told as they can withdraw from the study at any step if they feel so.
Author contribution
All authors equally contributed to the study concept or design, data collection, data analysis or interpretation, writing the paper.
Registration of research studies
-
1.
Name of the registry: http://www.researchregistry.com
-
2.
Unique Identifying number or registration ID: researchregistry5844
-
3.
Hyperlink to your specific registration (must be publicly accessible and will be checked): https://www.researchregistry.com/browse-the registry#home/registrationdetails/5fa9102a5030b800153ebb76/
Guarantor
Mr. Diriba Teshome.
Appendix A. Supplementary data
The following is the Supplementary data to this article:
References
- 1.Irct2015053122511N. Evaluating the quality of intra-venous regional anesthesia (IVRA) following adding dexamethasone or TNG to lidocaine. http://wwwwhoint/trialsearch/Trial2aspx?TrialID=IRCT2015053122511N1. 2015
- 2.Rozen W., Tran T., Ashton M., Barrington M., Ivanusic J., Taylor G. Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall. Clin. Anat.: Off. J. Am. Assoc. Clin. Anat. Br. Assoc. Clin. Anat. 2008;21(4):325–333. doi: 10.1002/ca.20621. [DOI] [PubMed] [Google Scholar]
- 3.Shabana A.M., Dar M., Ghanem M.A. Surgically performed rectus sheath block–effect of morphine added to bupivacaine versus bupivacaine only: a prospective randomized controlled double blinded trial. Egypt. J. Anaesth. 2013;29(4):401–405. [Google Scholar]
- 4.Wilkinson K.M., Krige A., Brearley S.G., Lane S., Scott M., Gordon A.C. Thoracic Epidural analgesia versus Rectus Sheath Catheters for open midline incisions in major abdominal surgery within an enhanced recovery programme (TERSC): study protocol for a randomised controlled trial. Trials. 2014;15(1):1–12. doi: 10.1186/1745-6215-15-400. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Imani F. Postoperative pain management. Anesthesiol. Pain Med. 2011;1(1):6. doi: 10.5812/kowsar.22287523.1810. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Block B.M., Liu S.S., Rowlingson A.J., Cowan A.R., Cowan J.A., Jr., Wu C.L. Efficacy of postoperative epidural analgesia: a meta-analysis. Jama. 2003;290(18):2455–2463. doi: 10.1001/jama.290.18.2455. [DOI] [PubMed] [Google Scholar]
- 7.Gharaei H., Imani F., Almasi F., Solimani M. The effect of ultrasound-guided TAPB on pain management after total abdominal hysterectomy. Kor. J. Pain. 2013;26(4):374. doi: 10.3344/kjp.2013.26.4.374. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Imani F., Faiz H.R., Sedaghat M., Hajiashrafi M. Effects of adding ketamine to fentanyl plus acetaminophen on postoperative pain by patient controlled analgesia in abdominal surgery. Anesthesiol. Pain Med. 2014;4(1) doi: 10.5812/aapm.12162. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Karbasy S.H., Derakhshan P. Effects of opium addiction on level of sensory block in spinal anesthesia with bupivacaine for lower abdomen and limb surgery: a case-control study. Anesthesiol. Pain Med. 2014;4(5) doi: 10.5812/aapm.21571. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Cousins M. Textbook of Pain. 1994. Acute and postoperative pain; p. 380. [Google Scholar]
- 11.Pasero C.L., McCaffery M. Pain in the elderly. AJN: Am. J. Nurs. 1996;96(10):39–45. [PubMed] [Google Scholar]
- 12.Dolan J., Lucie P., Geary T., Smith M., Kenny G.N. The rectus sheath block: accuracy of local anesthetic placement by trainee anesthesiologists using loss of resistance or ultrasound guidance. Reg. Anesth. Pain Med. 2009;34(3):247–250. doi: 10.1097/AAP.0b013e31819a3f67. 50. [DOI] [PubMed] [Google Scholar]
- 13.Hadzic’S TORA. HADZIC’S TEXTBOOK of REGIONAL ANESTHESIA and ACUTE PAIN MANAGEMENT Hadzic_FM_i-xxviii. Indd 1 24/02/17 4: 31 PM.
- 14.Seidel R., Wree A., Schulze M. Does the approach influence the success rate for ultrasound-guided rectus sheath blocks? An anatomical case series. Local Reg. Anesth. 2017;10:61. doi: 10.2147/LRA.S133500. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Chin K.J., McDonnell J.G., Carvalho B., Sharkey A., Pawa A., Gadsden J. Essentials of our current understanding: abdominal wall blocks. Reg. Anesth. Pain Med. 2017;42(2):133–183. doi: 10.1097/AAP.0000000000000545. [DOI] [PubMed] [Google Scholar]
- 16.Manassero A., Bossolasco M., Meineri M., Ugues S., Liarou C., Bertolaccini L. Spread patterns and effectiveness for surgery after ultrasound-guided rectus sheath block in adult day-case patients scheduled for umbilical hernia repair. J. Anaesthesiol. Clin. Pharmacol. 2015;31(3):349. doi: 10.4103/0970-9185.161671. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Børglum J., Jensen K. Abdominal Surgery Rijeka. InTech; Croatia: 2012. Abdominal surgery: advances in the use of ultrasound-guided truncal blocks for perioperative pain management; pp. 69–94. [Google Scholar]
- 18.Quek K.H.Y., Phua D.S.K. Bilateral rectus sheath block as the single anaesthetic technique for an open infraumbilical hernia repair. Singap. Med. J. 2014;55(3):e39. doi: 10.11622/smedj.2014042. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.McDonnell J.G., O'Donnell B.D., Farrell T., Gough N., Tuite D., Power C. Transversus abdominis plane block: a cadaveric and radiological evaluation. Reg. Anesth. Pain Med. 2007;32(5):399–404. doi: 10.1016/j.rapm.2007.03.011. [DOI] [PubMed] [Google Scholar]
- 20.Yarwood J., Berrill A. Nerve blocks of the anterior abdominal wall. Cont. Educ. Anaesth. Crit. Care Pain. 2010;10(6):182–186. [Google Scholar]
- 21.Cohen M., Quintner J., van Rysewyk S. Reconsidering the international association for the study of pain definition of pain. Pain Rep. 2018;3(2) doi: 10.1097/PR9.0000000000000634. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Yassin H.M., Abd Elmoneim A.T., El Moutaz H. The analgesic efficiency of ultrasound-guided rectus sheath analgesia compared with low thoracic epidural analgesia after elective abdominal surgery with a midline incision: a prospective randomized controlled trial. Anesthesiol. Pain Med. 2017;7(3) doi: 10.5812/aapm.14244. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Agha R., Abdall-Razak A., Crossley E., Dowlut N., Iosifidis C., Mathew G. STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery. Int. J. Surg. 2019;72:156–165. doi: 10.1016/j.ijsu.2019.11.002. [DOI] [PubMed] [Google Scholar]
- 24.Okamoto K., Komasawa N., Kido H., Kusaka Y., Sawai T., Minami T. Efficacy of transversus abdominis and rectus sheath blocks in combination with continuous intravenous fentanyl for postoperative analgesia of laparoscopic colectomy: a retrospective study. Masui: Jpn J. Anesthesiol. 2017;66(1):73–75. [PubMed] [Google Scholar]
- 25.Mudgalkar N., Bele S.D., Valsangkar S., Bodhare T.N., Gorre M. Utility of numerical and visual analog scales for evaluating the post-operative pain in rural patients. Indian J. Anaesth. 2012;56(6):553. doi: 10.4103/0019-5049.104573. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Uppal V., Sancheti S., Kalagara H. Transversus abdominis plane (TAP) and rectus sheath blocks: a technical description and evidence review. Curr.Anesthesiol. Rep. 2019;9(4):479–487. [Google Scholar]
- 27.Landmann A., Visoiu M., Malek M.M. Development of a novel technique for bilateral rectus sheath nerve blocks under laparoscopic-guidance. J. Pediatr. Surg. 2017;52(6):966–969. doi: 10.1016/j.jpedsurg.2017.03.020. [DOI] [PubMed] [Google Scholar]
- 28.Purdy M., Kinnunen M., Kokki M., Anttila M., Eskelinen M., Hautajärvi H. A prospective, randomized, open label, controlled study investigating the efficiency and safety of 3 different methods of rectus sheath block analgesia following midline laparotomy. Medicine. 2018;97(7) doi: 10.1097/MD.0000000000009968. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Bashandy G.M.N., Elkholy A.H.H. Reducing postoperative opioid consumption by adding an ultrasound-guided rectus sheath block to multimodal analgesia for abdominal cancer surgery with midline incision. Anesthesiol. Pain Med. 2014;4(3) doi: 10.5812/aapm.18263. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Ibrahim M., El Shamaa H., Ads E. Efficacy of combined ultrasound guided anterior and posterior rectus sheath block for postoperative analgesia following umbilical hernia repair: randomized, controlled trial. Egypt. J. Anaesth. 2016;32(4):519–526. [Google Scholar]
- 31.Smith B., Suchak M., Siggins D., Challands J. Rectus sheath block for diagnostic laparoscopy. Anaesthesia. 1988;43(11):947–948. doi: 10.1111/j.1365-2044.1988.tb05658.x. [DOI] [PubMed] [Google Scholar]
- 32.Allene M.D. Assessment of the analgesic effectiveness of bilateral rectus sheath block as postoperative analgesia for midline laparotomy: prospective observational cohort study. Int. J. Surg. Open. 2020;24:166–169. [Google Scholar]
- 33.Padmanabhan J., Rohatgi A., Niaz A., Chojnowska E., Baig K., Woods W. Does rectus sheath infusion of bupivacaine reduce postoperative opioid requirement? Ann. R. Coll. Surg. Engl. 2007;89(3):229–232. doi: 10.1308/003588407X168398. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Elbahrawy K., El-Deeb A. Rectus sheath block for postoperative analgesia in patients with mesenteric vascular occlusion undergoing laparotomy: a randomized single-blinded study. Anesth. Essays Res. 2016;10(3):516. doi: 10.4103/0259-1162.179315. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Crosbie E.J., Massiah N.S., Achiampong J.Y., Dolling S., Slade R.J. The surgical rectus sheath block for post-operative analgesia: a modern approach to an established technique. Eur. J. Obstet. Gynecol. Reprod. Biol. 2012;160(2):196–200. doi: 10.1016/j.ejogrb.2011.10.015. [DOI] [PubMed] [Google Scholar]
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Data and materials will be shared upon reasonable request.