Comparison of postoperative pain with and without rectus sheath block in patients undergoing midline laparotomy.

Abstract

Objective: To compare mean postoperative pain with and without rectus sheath block in patients undergoing midline laparotomy. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: April’24 to September’24. Methods: We enrolled 84 patients aged 13–60 years undergoing elective or emergency midline laparotomy who were randomly assigned to two groups: Group A (RSB group) and Group B (non-RSB group). RSB was performed using a landmark-based technique with 0.25% bupivacaine. Pain intensity was measured at 1, 4, 12, and 24 hours following surgery using the Visual Analogue Scale (VAS).Rescue analgesic requirements were also recorded. Results: The RSB group showed significantly lower VAS scores at 1 hour (2.46 ± 0.73 vs. 4.56 ± 0.69, p = 0.000) and 24 hours (4.51 ± 0.62 vs. 4.82 ± 0.74, p = 0.041). Mean rescue analgesic doses were also significantly lower in the RSB group (1.12 ± 0.77 vs. 2.74 ± 1.13, p = 0.000). Demographics were comparable across groups, with 63.1% males and 50% ASA I status. Findings align with 12 supporting studies, suggesting consistent benefit of RSB in terms of pain control and opioid-sparing effects. Conclusion: Landmark-guided rectus sheath block significantly reduces postoperative pain and opioid use in midline laparotomy. Its efficacy is comparable to ultrasound-guided methods and may be enhanced through preoperative timing and adjuvant use. RSB is a valuable tool, especially in settings lacking advanced imaging.