Ultrasound guided rectus sheath block in management of pain in laparoscopic tubal ligation

Abstract

Background & objectives: Laparoscopic tubal ligation (LTL) is a day care surgery and requires a small supraumbilical incision for the umbilical port. Pain after LTL is more than diagnostic laparoscopy. We aimed to examine the efficacy and benefits of a preemptive ultrasound guided single injection rectus sheath block (RSB) in providing improved early on postoperative pain scores in comparison to general anesthesia alone.

Methodology: Sixty patients underwent elective LTL, were randomly allocated by a computer generated list into two groups: the ultrasound guided rectus sheath block group – the Group R, received a bilateral RSB using 20 ml of 0.25% bupivacaine on either side after initiation of anesthesia and earlier than the surgical incision; and general anesthesia group – the Group G, received general anesthesia alone. Intravenous tramadol was also given and its time was recorded. Pain was measured by verbal analogue score (VAS). Sedation score (from 0 awake to 5 unarousable) was used to record sedation level. Any adverse events were recorded. Statistical Analysis was done with the help of SPSS software version 15. Mann-Whitney U-test, t-test, Pearson χ2 test and Fisher’s exact test was used for analysis of different variables. Statistical significance was set at 5%.

Results: The rectus sheath block with bupivacaine compared with control group reduced verbal analogue scores. Tramadol requirement in the first 12 postoperative hours was also reduced. The frequency of nausea and sedation was compact in the Group R. There were no complications associated with the rectus sheath block.