ABSTRACT
OBJECTIVE: To investigate the postoperative analgesic effects of rectus sheath block (RSB) in combination with patient-controlled analgesia (PCA) compared with PCA alone after single-port total laparoscopic hysterectomy (TLH). METHODS: This randomized, single-blind study enrolled female patients that underwent single-port TLH. The patients were randomized to receive either fentanyl PCA (PCA group) or RSB with the same PCA. The primary outcomes were fentanyl consumption at 8 h postoperatively and visual analogue scale (VAS) pain scores, which represented the severity of postoperative pain. RESULTS: A total of 36 patients were enrolled in the study: 18 in the PCA group and 18 in the RSB group (two patients were excluded). The primary outcome of fentanyl consumption was significantly lower at 8 h postoperatively in the RSB group than in the PCA group (148 ± 61 µg versus 222 ± 107 µg, respectively). VAS scores were significantly lower at arrival in the post-anaesthesia care unit and at 30 min after arrival in the RSB group compared with the PCA group. There were no significant differences in the nausea/vomiting score and in additional analgesic consumption between the two groups. CONCLUSIONS: RSB can be used as a multimodal approach for pain control in single-port TLH procedures.Clinical Research Information Service (no. KCT0001461).
Subject(s)
Laparoscopy , Nerve Block , Humans , Female , Nerve Block/methods , Single-Blind Method , Analgesia, Patient-Controlled/methods , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Hysterectomy/adverse effects , Fentanyl/therapeutic use , Analgesics , Laparoscopy/methods , Analgesics, Opioid/therapeutic useABSTRACT
RATIONALE: Functional abdominal pain is an intractable medical condition that often reduces quality of life. Celiac plexus block is a representative intervention for managing intractable abdominal pain. However, celiac plexus block can be technically difficult to perform and carries the risk of potential complications. During erector spinae plane block (ESPB), the injectate can enter the paravertebral space and reach the sympathetic chain. If local anesthetics spread to the sympathetic chain that supplies fibers to the splanchnic nerve, abdominal pain theoretically could be reduced. PATIENT CONCERNS: Three patients suffered from abdominal pain of unknown cause, and no medical abnormalities were found in various examinations. DIAGNOSIS: As a result of collaboration with related medical departments, the abdominal symptoms of the patients were suspected to be functional abdominal pain. INTERVENTIONS: We successfully controlled symptoms by performing ESPB at the lower thoracic level in 3 patients with functional abdominal pain. OUTCOMES: After the procedure, the patients' abdominal pain improved significantly over several months. LESSONS: We suggest that lower thoracic ESPB could be an option for management of functional abdominal pain.
