The Clinical Application Of Ultrasound-guided Rectus Sheath Block For Midline Incisions In Lower Abdominal Surgery

Objective: The aim of this clinical trail was to observe the analgesia of ultrasound-guided rectus sheath block in patients undergoing lower abdominal median incision surgery.Methods: 40 patients with abdominal midline incision surgery under general anesthesia were enrolled. Those patients were randomly divided into general anesthesia combined with the rectus sheath block group(Group R) and general anesthesia group(Group C). There were 20 patients in each group.Implement ultrasound-guided rectus sheath block between general anesthesia and cutting skin.Group R was injected 0.375% bupivacaine 30 m L. The parameters of patients were recorded including the hemodynamic changes after cutting skin,dosages of fentanyl during operation,the length of stay and additional dosages of fentanyl in post anaesthesia care unit. Visual analogue scale was also recorded in 2h、6h、10h、24h after the surgery. When VAS≥4, afford flurbiprofen axetil. Note the dosages of flurbiprofen axetil in postoperative days(POD) 0, 1 and 2.Results: 1. Systolic blood pressure、 diastolic blood pressure and heart rate in group R was lower than group C in 3min、2h after cutting the skin(P <0.05).Systolic blood pressure、 diastolic blood pressure and heart rate of both groups had no significant differences during preoperative moments and in 20min、1h、4h、6h after incising the skin(P>0.05). 2. Dosages of fentanyl in group R(0.46 ± 0.07mg) was significantly lower than group C(0.54±0.13 mg)(P <0.05). The time to extubate in group R(4.65± 3.28min) was obviously less than group C(10.45±6.75min)(P <0.01). 3. Dosages of supplemental fentanyl in Group R(0.01±0.02mg) was evidently lower than group C(0.07±0.04mg)in post anaesthesia care unit(P <0.01). The length of stay in group R(29.50±6.06min) was significantly less than group C in post anaesthesia care unit(45.70± 11.37min)(P <0.01). 4. Dosages of flurbiprofen axetil in group R was significantly less than group C on postoperative day 0(P <0.01). Dosages of flurbiprofen axetil in both groups had no significant differences on postoperative day 1,2(P>0.05). 5. VAS scores in group R was lower than group C in 2h、6h、10h after the surgery(P <0.05),but both groups had no significant differences in 24 h after surgery(P >0.05). 6. The incidence of nausea in group R was lower compared with group C(P <0.05). The patients who were in group R had no adverse reactions caused by rectus sheath block.Conclusion: 1. Ultrasound-guided rectus sheath block has analgesia tangibly. It can be used as one of effective components of multimodal analgesia.This technology is easy to master. It is convenient to popularize and apply. 2. Ultrasound-guided rectus sheath block has many advantages such as intraoperative hemodynamic stability, significantly reducing the use of intraoperative and postoperative analgesic drugs.