Measuring the analgesic effect of adding pre-operative single-shot rectus sheath blocks to postoperative rectus sheath continuous blocks for major urological surgery: a double-blind randomised study
rectus sheath blocks, urological surgery
Continuous rectus sheath block offers an alternative to epidural analgesia for postoperative analgesia after midline abdominal surgery.1–4 Catheters can be placed under ultrasound guidance3 or under direct vision during closure of the surgical incision.2 A disadvantage of surgically placed rectus sheath catheters is that they are inserted at the end of surgery. Therefore, unlike epidural catheters inserted pre-operatively, the patient does not benefit intra-operatively and the block may not be fully established in the early recovery phase of care. We hypothesised that the addition of ultrasound-guided pre-operative bilateral single-shot rectus sheath blocks to surgically inserted postoperative continuous rectus sheath blocks would improve postoperative analgesia in the first 24 h after surgery. To this end, we designed a prospective, randomised, double-blind, placebo-controlled trial where the primary outcome was opioid consumption in the first 24 h postoperatively. Secondary outcomes included intra-operative opioid requirement, and Numerical Rating Scale (NRS)-11 pain scores in the postanaesthesia care unit (PACU) and at 24 and 48 h postoperatively. This study was approved by the Health Research Ethics Board of the University of Alberta (protocol number 00078459, date of registration 7 February 2018, ClinicalTrials.gov identifier: NCT03458598).
Green, James & Niu, Shuang & Verrier, Michelle & Buro, Karen & Lupul, Nicholas & Douglas, Chris & Fairey, Adrian & Dillane, Derek. (2021). Measuring the analgesic effect of adding pre-operative single-shot rectus sheath blocks to postoperative rectus sheath continuous blocks for major urological surgery: A double-blind randomised study. European Journal of Anaesthesiology. 38. 187-189. DOI: 10.1097/EJA.0000000000001306.
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