Ultrasound guided abdominal field blocks improve postoperative pain relief in cesarean delivery: a prospective randomized controlled study

Background: Abdominal field blocks with local anesthetic solutions have been suggested in postoperative analgesia in patients undergoing abdominal wall incisions. In the present study we assessed the analgesic efficacy of ultrasound guided rectus sheath and transversus abdominis plane blocks over first 24 postoperative hours after cesarean deliveries performed through pfannensteil or midline incisions

Methodology: Sixty women undergoing elective or emergency cesarean delivery were enrolled in this randomized, controlled, double-blind trial, and then randomized either to undergo ultrasound guided rectus sheath and transversus abdominis plane blocks with bupivacaine [n=30] or no block [n=30]. Inj diclofenac and inj. paracetamol 1 G, were given to all patients, and inj tramadol was given on request as a rescue analgesic. All patients received a spinal anesthesia with 0.5% heavy bupivacaine, and at the end of surgery [after the skin sutures] bilateral rectus sheath and transversus abdominis plane blocks were performed using 15 to 20 ml of 0.25% bupivacaine in each block on either side [to maximal dose of 3 mg/kg] and no block in the control patients. Each patient was evaluated postoperatively by a blinded investigator at 2, 4, 6, 12 and 24 h postoperatively

Results: Ultrasound guided abdominal field blocks with 0.25% bupivacaine reduced the total tramadol requirement in the first 24 postoperative hours [157 +/- 50.709 vs 386.67 +/- 29.16 mg] and also the visual analogue pain scores at 2 [2 vs 8], 4 [2 vs 8],6 [2 vs 8],12 [4 vs 7] and 24 [4 vs 7] hours postoperatively. No significant difference was found between groups in the incidence of nausea. Sedation was reduced in the patients who received the blocks. There were no complications attributed to the blocks

Conclusion: Ultrasound guided abdominal field blocks, as a part of a multimodal analgesic regimen, provided greater analgesia up to 24 h postoperatively after elective or emergency cesarean delivery

Ultrasound guided rectus sheath block in management of pain in laparoscopic tubal ligation

Background and objectives: Laparoscopic tubal ligation [LTL] is a day care surgery and requires a small supraumbilical incision for the umbilical port. Pain after LTL is more than diagnostic laparoscopy. We aimed to examine the efficacy and benefits of a preemptive ultrasound guided single injection rectus sheath block [RSB] in providing improved early on postoperative pain scores in comparison to general anesthesia alone

Methodology: Sixty patients underwent elective LTL, were randomly allocated by a computer generated list into two groups: the ultrasound guided rectus sheath block group - the Group R, received a bilateral RSB using 20 ml of 0.25% bupivacaine on either side after initiation of anesthesia and earlier than the surgical incision; and general anesthesia group - the Group G, received general anesthesia alone. Intravenous tramadol was also given and its time was recorded. Pain was measured by verbal analogue score [VAS]. Sedation score [from 0 awake to 5 unarousable] was used to record sedation level. Any adverse events were recorded. Statistical Analysis was done with the help of SPSS software version 15. Mann-Whitney U-test, t-test, Pearson ?[2] test and Fisher's exact test was used for analysis of different variables. Statistical significance was set at 5%

Results: The rectus sheath block with bupivacaine compared with control group reduced verbal analogue scores. Tramadol requirements in the first 12 postoperative hours were also lower. The frequency of nausea and sedation was reduced in the Group R. There were no complications accredited to the rectus sheath block

Conclusion: Ultrasound guided rectus sheath block, as a part of multimodal analgesic regimen, provides superior analgesia up to 12 postoperative hours after voluntary laparoscopic tubal ligation