Ultrasound-Guided Rectus Sheath Block Versus Local Infiltration

N/ANot Yet RecruitingNCT07582029

Sisli Hamidiye Etfal Training and Research Hospital60 enrolled

Overview

Laparoscopic cholecystectomy is associated with significant postoperative pain originating from trocar sites, pneumoperitoneum, and visceral irritation. Both local anesthetic infiltration and ultrasound-guided rectus sheath block are commonly used regional analgesic techniques to reduce postoperative pain and opioid consumption. This prospective randomized controlled study aims to compare the effects of these two techniques on postoperative pain scores, opioid requirements, and analgesia-related adverse effects following laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is a very commonly performed and painful surgical procedure. The etiology of pain is complex and commonly includes pain related to trocar insertion sites, pain secondary to carbon dioxide insufflation, visceral pain, and shoulder pain. Various analgesic medications and regional anesthesia techniques are used for postoperative pain management. Abdominal wall blocks are frequently utilized to reduce opioid-related adverse effects. Rectus sheath block is a regional anesthesia technique that blocks the anterior cutaneous branches of the lower thoracic nerves (T7-T12) and is used for analgesia in laparoscopic surgeries. Several studies have demonstrated that local anesthetic infiltration provides effective analgesia in laparoscopic cholecystectomy. Although rectus sheath block is an old technique traditionally used in midline surgeries, its analgesic use in laparoscopic procedures has increased in recent years. In this prospective randomized clinical trial, we aimed to compare the effects of Local Anesthetic Infiltration and Rectus Sheath Block on opioid consumption and pain scores in laparoscopic gallbladder surgery. To compare the effects of Local Anesthetic Infiltration and Rectus Sheath Block on opioid consumption and pain scores in laparoscopic gallbladder surgery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Interventions

Rectus Sheath BlockPROCEDURE

After completion of the operation, during the surgical closure phase, bilateral rectus sheath block will be performed. A linear ultrasound probe will be placed transversely over the umbilicus and 1 cm lateral to it. After visualization of the rectus abdominis muscle and posterior rectus sheath, a 22-Gauge 80 mm block needle (Braun Stimuplex Ultra-360, Melsungen, Germany) will be advanced from lateral to medial using the in-plane technique. Following hydrodissection with 1 mL saline between the rectus muscle and posterior sheath and confirmation of appropriate spread, 20 mL local anesthetic (0.25% bupivacaine) will be administered with intermittent negative aspiration.

Local Anesthetic InfiltrationPROCEDURE

At the end of the operation, the surgeon will infiltrate 5 mL local anesthetic (0.5% bupivacaine) subcutaneously into each of the four trocar insertion sites.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * ASA (American Society of Anesthesiologists) class I-II patients * Patients aged between 18 and 65 years * Patients undergoing laparoscopic cholecystectomy surgery Exclusion Criteria: * ASA class III-IV patients * Patients undergoing emergency surgery * Relatives of patients who do not provide consent * Presence of chronic pain * Chronic opioid use * Presence of local anesthetic allergy * Ibuprofen allergy * Paracetamol allergy * Presence of infection at the block site * Coagulopathy * Increased intracranial pressure * Pre-existing neurological deficit * Severe organ failure * Mental retardation * Anatomical deformity

Outcomes

Primary Outcomes

NRS Score

Postoperative pain assessment will be performed using the Numeric Rating Scale (NRS). The NRS is a scale in which patients rate their pain intensity numerically from 0 (no pain) to 10 (worst imaginable pain).

Time frame: Pain scores will be assessed and recorded at postoperative 0, 1, 4, 12, and 24 hours.

Secondary Outcomes

Opioid Consumption

Postoperative opioid consumption will be evaluated using intravenous patient-controlled analgesia (IV PCA) over 24 hours. PCA will be set in bolus-only mode (10 mg tramadol), without continuous infusion. Patients will be educated preoperatively regarding PCA use and instructed to administer boluses in case of pain. At the end of 24 hours, total opioid consumption will be recorded from the device data, and the time to first bolus administration (time to first analgesic requirement) will also be evaluated.

Time frame: 24 hour

Adverse Effects

Adverse effects such as hypotension, bradycardia, nausea, vomiting, and local anesthetic systemic toxicity (LAST) occurring within the first 24 postoperative hours will be monitored and recorded.