PROSPECTIVE STUDY OF ANALGESIC EFFICACY OF RECTUS SHEATH BLOCK IN PATIENTS UNDERGOING LAPAROTOMY FOR POSTOPERATIVE PAIN CONTROL IN COMPARISION WITH CONVENTIONAL ANALGESIC TECHNIQUES

Abstract

Background: Open abdominal surgeries are commonly performed. Pain in the postoperative period prevents early ambulation of the patient. This increases risk of deep vein thrombosis, pulmonary atelectasis which predisposes patients to increased morbidity, prolonged duration of hospital stay and mortality sometimes. Surgically placed Rectus sheath catheter is safe and provides good pain relief in most of the patients. Aims and Objectives: To compare the efficacy of Rectus sheath catheter block with conventional analgesia technique in post operative pain control. To assess the safety of Rectus sheath catheter block analgesia Methodology: 60 patients who underwent laparotomy at R.L.Jalappa Hospital, Kolar from September 2022 to June 2024 were included in the study after fulfilling inclusion criteria , patients were divided into study group with Rectus sheath catheter block( RSB) and control group with conventional analgesia (CA) administration. Post operative pain is evaluated in both the groups using VAS, NRS and ANVP pain scores, and time for requirement of analgesia was observed .secondary complications like nausea, vomiting, tachycardia / bradycardia were studied and noted after 1, 6, 12, 24,36 and 48 hours postoperatively . Analgesic efficacy, secondary complications occurrence and requirement of analgesia were noted and compared in two groups. xvi Results: Based on VAS score 40% of the cases had mild pain and 10% of the cases had moderate pain in RSB group, however 25% of the cases had mild pain, 21.7% of the cases had moderate pain and 3.3% of the cases had worst pain in CA group respectively. There was significant association noted between RSB group and CA group for pain in our study (p value =0.035).On assessing the pain based on NRS 33.3%, 15% and 1.7% of the patients had mild, moderate and severe pain in RSB group respectively while 20%, 21.7% and 8.3% of the cases had mild, moderate and severe pain among CA group respectively. The association between RSB group and CA group cases based on VAS for pain was significant (p value =0.037).Based on ANVP scale significant difference was noted between the groups at 1st hour, 6 hours and 12 hours of postoperative period with p values of 0.002, 0.0002 and 0.010 respectively. However, difference in ANVP score at 24 hours to 48 hours was noted as insignificant. Specific adverse events like hypotension, bradycardia and PONV were seen among 14.3% of the cases in RSB group each while in CA group 14.3%, 14.3% and 28.6% of the cases had hypotension, bradycardia and PONV respectively. No significant association was recorded between the two groups based on specific adverse events. Rescue analgesia within 24 hrs were required among 1.7% of the patients in RSB group and 20% of the cases in CA group. There was highly significant statistical association noted for rescue analgesia between the groups with CA group cases requiring more rescue analgesia (p value =0.0005). The median diclofenac consumption was 75 mg and 150 mg among RSB and CA group respectively. The median diclofenac requirement was statistically significant between the groups (p value = <0.0001) Conclusion: Rectus sheath catheter block provides good postoperative analgesia with out any complications like tachycardia, postoperative nausea and vomiting and very rare requirement of rescue analgesia.