The Opioid-sparing Effect Of Incision-based Rectus Sheath Block During Open Gastrectomy

Background: At present,epidural analgesia is still the gold standard of postoperative analgesia for abdominal surgery.However,the complications and contraindications of epidural analgesia limit its use.With the promotion of the concept of accelerated rehabilitation surgery and the development of ultrasound visualization technology,the clinical application of nerve block is more and more extensive.The application of this technology could reduce the use of opioids and thus the associated side effects.The application of transverse abdominis plane block in gastrointestinal surgery has been widely reported,but the application of rectus sheath block in gastrointestinal surgery has not been systematically studied.However,at present,nerve block is mostly used for postoperative analgesia or to reduce the consumption of opioids after surgery.There is no large number of studies on the realization of intraoperative opioids removal.The large amount of opioids used during the operation may induce postoperative hyperalgesia.Objective:The aim of this prospective,randomized controlled study was to investigate whether incision-based rectus sheath block can reduce or completely avoid intraoperative opioids(remifentanil)and improve clinical outcomes in patients with open gastrectomy.Methods:64 patients under the age of 85 who planned to undergo selective open gastrectomy under general anesthesia were divided into 2 groups randomly:control group(conventional general anesthesia group,CAG group)and experimental group(rectus sheath block group,RSB group).Two groups of patients were performed routine anesthesia induction,the experimental group based in anesthesia induction after ultrasound guided incision on both sides of the 2 points four rectus sheath block,using0.375% of ropivacaine 40 ml(add adjuvants dexamethasone 5 mg),maintain anesthesia with propofol,remifentanil,dexmedetomidine,maintain the BIS value between 40 ～ 60,MAP and HR at baseline level of around 20%.Outcome Measures:The primary outcome is in the use of intraoperatie remifentanil,secondary outcome including the incidence of postoperative delirium,Vital signs(mean arterial pressure and heart rate)at each time point during the operation,postoperative pain scores 48 hours,the first time of postoperative analgesia pump pressure time,the number of pressure of analgesia pump in 48 hours after operation,the incidence of adverse reactions except for delirium,the first time to get out of bed and fart after surgery,postoperative length of stay.Results: Compared with 1091(715.75,1342.38)μg in the control group,the intraoperative consumption of remifentanil in the experimental group was significantly reduced by 0(0,0)μg(P<0.001),and the intraoperative use of sufentanil was also decreased(P<0.001).The MAP of the experimental group was lower than that of the CGA group after 1 minute intraperitoneal exploration,and the HR of the experimental group was lower than that of the CGA group at the moment of 1 minute and 3 minutes of exploration(P<0.05).The frequency of analgesia pump in the RSB group at 24 h and48h after operation was lower than that in the control group(P < 0.05),the time to press the analgesia pump for the first time after surgery also varies at 2,4,8 hour(P =0.014),pain scores at rest decreased at 2,4,8,12 hours after surgery(P<0.05),pain scores at coughing also decreased at 2,4,8,12 hours after surgery(P<0.05),the time of first farts after surgery is earlier(P = 0.04),the time of postoperative hospitalization shorten(P = 0.047).Conclusion: Ultrasound guided incision based on both sides of the 2 points four rectus sheath block can reduce the line open stomach surgery patients with intraoperative opioid consumption,the hemodynamics of the patients are smoother during abdominal exploration,prolong patients postoperative analgesia pump press time for the first time,reduce the number of analgesia pump pressure times within 48 hours after surgery,postoperative pain scores decreased,advance the time of first farting after surgery,reduce the length of hospital stay after surgery.Trial registration:Clinical Trials.gov,NCT04306159(date of registration February2020)...