The analgesic efficacy of ultrasound-guided rectus sheath block among living liver donors surgery: A single center experience
Bolormaa Lkhamsuren1, Bazarragchaa Regjii1, Odonchimeg Gombosuren1, Davaajargal Buuvei1, Chuluunbaatar Donkhim1, Ganbold Lundeg2, Bayalagmaa Khuvtsagaan1.
1Organ transplantation center, First Central hospital of Mongolia, Ulaanbaatar, Mongolia; 2Anesthesia and intensive care department, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
Introduction: Effective pain control after abdominal surgery improves postoperative rehabilitation and enhances recovery. With this study, we aimed to evaluate the efficacy of postoperative analgesia with ultrasound-guided rectus sheath block among living liver donors following open liver resection surgery with J incision.
Objectives: We investigated whether the ultrasound-guided rectus sheath block reduced the postoperative pain intensity, decreased the additional opioid consumption, and improved patient satisfaction.
Methods: We selected a total of 35 living liver donors, whose scheduled for open liver resection surgery between February 1, 2023, to March 1, 2024, in the First Central Hospital of Mongolia, and randomly divided into two groups. The study group (n=15) was given a rectus sheath block once at skin closure using ropivacaine 0.375% - 40 mL under ultrasound guidance and the control group (n=20) was without block. A disposable PCA pump (flow rate 2 mL/h, bolus dose 0.5 mL/15 min) containing fentanyl 0.001%-100 mL was attached to both groups immediately following recovery from anesthesia. Postoperative pain assessment was performed with a VAS according to the previous study. The amount of postoperative additional fentanyl and number of pump bolus were registered in PACU in PO settings at 6, 12, and 24 hours.
Results: The study group used significantly less fentanyl (41.6±21 µg) than the control group (125±84 µg). The number of disposable PCA pump bolus was significantly lower in the study group (0.5±0.9) than in the control group (1.9±0.5) in PO first 6 hours after the surgery. But at 12 and 24 hours there were no significant differences between the two groups. The VAS score was measured lower in the study group by 2.05±0.6 in PO first 6 hours and 0.5±0.2 at 12 hours and no significant differences at 24 hours.
Conclusions: Ultrasound-guided unilateral rectus sheath block using ropivacaine was significantly effective reduced additional opioid consumption and improved satisfaction in living liver donors who underwent open liver resection surgery with J incision.
Abbreviations: VAS - Visual analog scale, PCA – Patient-controlled analgesia, PO - Postoperative
Keywords: Rectus sheath block, analgesia, postoperative pain, ropivacaine, opioid, disposable PCA pump
