Author : Arti Kuldeep, Ravindra Gehlot, Mukesh Sharma, Krishan Gopal Jangir, Lalit Kumar Raiger
Abstract : Background: In the modern setting the rectus sheath block (RSB) has been found effective in decreasing
opioid requirement after both diagnostic and interventional laparoscopy and laparotomy. Efficacy of rectus
sheath block (RSB) using ropivacaine versus bupivacaine for acute postoperative pain relief is not much
Material and Methods: 90 patients undergoing elective midline abdominal surgeries under general
anaesthesia were randomly divided into three groups of 30 patients each, destined to receive bilateral rectus
sheath block using 15 ml on each side (total 30 ml) of 0.25% ropivacaine in Group R, 0.25% bupivacaine in
Group B or normal saline in Group C. Three groups were compared regarding time to first rescue analgesic
from time of RSB (duration of analgesia), total rescue analgesic (tramadol) consumption in first 10 hours,
visual analogue score (VAS), satisfaction score and adverse effects.
Result: Mean duration of analgesia was significantly longer in group R (5.780.93h) than group B
(3.63+0.90 h) and group C (2.37+0.44 h), p group B > group C). This trend was
observed in both hernia repair and laparotomy. Rescue analgesic consumption in terms of number of doses
was significantly less in Group R (30) than in Group B (38) than in Group C (59), p
significantly less and patient satisfaction was significantly better in Group R than in Group B than in Group
Conclusion: Bilateral single shot rectus sheath block (RSB) using isobaric ropivacaine (0.25%) or
bupivacaine (0.25%) is a safe and effective method of providing postoperative analgesia to patients
undergoing midline abdominal surgeries. The lower cardio toxicity profile with the excellent prolonged
postoperative analgesia makes ropivacaine an excellent choice for the RSB as compared to bupivacaine.
Keywords: Rectus sheath block, Ropivacaine, Bupivacaine, Laparotomies.