Regional Blocks for Multimodal Perioperative Analgesia for Adults Undergoing Para-Umbilical Hernia Repair: A Randomized Controlled Trial.

Abstract

Background: It is controversial whether ultrasound-guided rectus sheath block (RSB) is superior to field block (FB) in providing postoperative analgesia and obtunding the stress response to surgery for patients undergoing para-umbilical hernia repair.

Methods: A prospective randomized controlled trial (RCT) was designed to compare the effects of ultrasound-guided RSB to FB for the provision of multimodal perioperative analgesia in adult patients undergoing para-umbilical hernia repair under balanced general anesthesia. After receiving standardized general anesthesia, 75 patients (ASA I, II) were randomized to one of the following three groups: a) RSB group receiving bilateral ultrasound-guided RSB using 0.3ml.kg-1 of Bupivacaine 0.5% plus a sham field block, b) FB group receiving a field block using the same volume of Bupivacaine 0.5% plus a sham rectus sheath block, c) control group receiving two sham blocks. All Patients received intravenously 1g of paracetamol 6 hourly and 75 mg of diclofenac 12 hourly starting after induction of anesthesia.

Results: The median Visual analogue score (VAS) was significantly lower in the RSB group compared to the other two groups in the immediate postoperative period as well as 2, 4, and 6 hours postoperatively (p< 0.001, for all times). In addition, the RSB group showed a better hemodynamic profile and lower catecholamine levels than the FB group.

Conclusion: RSB is superior to both FB and placebo as part of a multimodal perioperative analgesia regimen in adult patients undergoing para-umbilical hernia repair in terms of analgesia, cardiovascular stability, and suppression of the examined hormonal response to surgery.