Analgesic effects of rectus sheath block with two kinds of different local anesthetics guided by ultrasound in abdominal surgery

WANG Chang-sheng; WANG Miao; Chen Gong-jin

doi:10.13820/j.cnki.gdyx.20243787

Abstract：Objective To evaluate the efficacy and safety of ultrasound-guided rectus sheath block with two dif-ferent local anesthetics for postoperative analgesia in abdominal surgery.Methods A total of 90 patients who underwent abdominal midline incision surgery under general anesthesia at the Shaoxing Second Hospital Medical Community General Hospital between November 2023 and July 2024 were enrolled.Patients were randomized into three groups(n=30 each):liposomal bupivacaine group(Group A),bupivacaine hydrochloride group(Group B),and control group(Group C).Group A received ultrasound-guided bilateral rectus sheath block with 10 mL(133 mg)liposomal bupivacaine plus 10 mL normal saline per side;Group B received 20 mL of 0.25％bupivacaine hydrochloride per side;Group C did not un-dergo nerve block.The primary outcome was the visual analogue scale(VAS)score at 48 h postoperatively.Secondary outcomes included VAS scores at PACU and 12,24,and 72 h postoperatively,patient-controlled analgesia(PCA)press times and drug consumption at 24 and 48 h,rescue analgesia use,length of hospital stay,and adverse events.Results Compared with Group C,both Groups A and B had significantly lower VAS scores at PACU and at 12,24,48,and 72 h postoperatively(P＜0.05).Group A had significantly lower VAS scores at 24 h and 48 h than Group B(P＜0.05).PCA press times and drug consumption at 24 h and 48 h were significantly reduced in Groups A and B compared with Group C(P＜0.05).Group A showed lower PCA press times and drug consumption at 48 h compared with Group B(P＜0.05).No significant differences were found among the three groups in rescue analgesia requirements or hospital stay(P＞0.05).The incidence of anesthesia-related adverse events,including nausea,vomiting,dizziness,and pruritus,did not differ significantly among groups(P＞0.05).No puncture-related complications occurred in Groups A or B.Conclusion Ultrasound-guided rectus sheath block with liposomal bupivacaine provides superior analgesia within 72 h after abdominal midline incision surgery compared with bupivacaine hydrochloride,without increasing adverse events.