A Randomised controlled study comparing the analgesic efficacy of Thoracic Epidural Analgesia Versus Ultrasound Guided Rectus Sheath Block for Midline Laparotomy Surgery

BACKGROUND: Many techniques of multimodal analgesia have been considered in the past to provide adequate analgesia in midline laparotomy surgeries with the aim of reducing postoperative consumption of opioids. The advent of Ultrasonogram has facilitated the anaesthesiologist in reconsidering the older techniques. Rectus sheath block is one of those useful techniques. AIM OF THE STUDY: Our study examined the postoperative analgesic efficacy of Rectus sheath block (RSB) compared to the Thoracic epidural analgesia (TEA). METHODS: 100 patient were enrolled in this randomised controlled study. The patients were allocated in 2 groups. In all the patients the midline laparotomy was performed under general anaesthesia. In the RSB group patient rectus sheath catheters were placed using ultrasonogram after induction of anaesthesia. In TEA group patient epidural catheters were positioned prior to induction of anaesthesia. Intermittent bolus of bupivacaine was used 6 hourly for 48 hours postoperatively. Both the groups were compared postoperatively for Visual analogue Scores, PONV, patient satisfaction, requirement of rescue analgesia and failure rate. RESULTS: There was no substantial demographic differences between the groups. The median VAS scores between the two groups were comparable. The incidence of mean MAP was lower in TEA group than RSB group. The incidence of hypotension was statistically significant in TEA group. Other haemodynamic parameters and side effects were comparable between the two groups. CONCLUSION: The Study showed that in patients undergoing midline laparotomy surgeries the postoperative analgesia using rectus sheath block is comparable with epidural analgesia. It can be an effective alternative to epidural analgesia and without the complications associated with it