Efficacy of Ultrasound Guided Rectus Sheath Block on Post Operative Quality of Recovery

Study Overview
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Brief Summary
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Effective Postoperative pain management following laparotomy represents a cornerstone in the care of surgical patients. With the growing utilization of Enhanced recovery after surgery protocols (ERAS), a paradigm shift in perioperative care has resulted in reduction of both hospital stay and clinical complications faced by patients. One important component of successful implementation of ERAS protocol is optimized pain control. It has been shown that opioids have a considerable role in reducing bowel motility in addition; it hinders early mobilization and enteral feeding besides their commonly faced side effects such as nausea and vomiting. Consequently, ERAS programs encourage the usage of multimodal opioid sparing analgesia which includes neuraxial or regional anesthesia techniques to provide effective pain relief while reducing the opioid related side effects. [1] Regional blocks have remained popular with evidence of superior postoperative pain control when compared with systemic analgesics. Regional anaesthesia techniques have undergone considerable refinement with the advent of ultrasound guidance. Ultrasound visualization of anatomical structures increases both the safety and quality of regional blocks through optimal needle placement. Ultrasound-guided rectus sheath (RS) blocks are an emerging anaesthetic technique providing excellent analgesia after laparotomy. The anatomic characteristics of this block suggest minimal serious complications are likely, and this regional block is particularly useful where epidural is contraindicated

Official Title
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Efficacy of Ultrasound Guided Rectus Sheath Block Combined With General Anaesthesia on the Postoperative Quality of Recovery Profile in Laparotomy Surgeries, Randomized Control Trial.

Conditions
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Postoperative Pain

Intervention / Treatment
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* Procedure: rectus sheath block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18-60 years old patients ASA 1-2 patients Patients undergoing elective midline laparotomy. Exclusion Criteria: 1. refusal to consent, 2. previous laparotomy (subsequently amended to exclude only a laparotomy with a paramedian scar), 3. significant hepatic or renal disease, 4. any condition limiting the use of co-analgesics (diclofenac and acetaminophen), 5. coagulopathy (international normalized ratio: 1.5 ) 6. Patients with body weight \ 50 kg.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Rectus sheath block<br> | Procedure: rectus sheath block<br>* blocking the nerve underneath the rectus muscle by bupivicaine<br>|
| Placebo Comparator: Control<br> | Procedure: rectus sheath block<br>* blocking the nerve underneath the rectus muscle by bupivicaine<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| quality of recovery | using QOR-15 questionnaire | 24 hours |