The Effect of Ultrasound Guided Rectus Sheath Block Versus Transversus Abdominis Plane Block for Pain Relief after Total Abdominal Hysterectomy

Abstract
Background: Total abdominal hysterectomy (TAH) is associated with substantial postoperative pain and discomfort. Transversus abdominis plane (TAP) block and rectus sheath (RS) block are used to block the sensory nerves of the anterior abdominal wall and thereby contributing in pain relief after lower abdominal surgeries.
Aim of Study: The aim of this study is to evaluate the effect of postoperative bilateral US-guided RS block versus postoperative bilateral US-guided TAB on analgesic require-ments and hemodynamic changes after TAH.
Patients and Methods: This prospective randomized study was carried out on 60 females, ASA I or II presented for elective TAH under general anesthesia (GA)and randomly classified into 2 equal groups (each of 30 patients); patients in group I received RS block with 40ml bupivacaine 0.25% (20ml each side) before the end of surgery and in group II, patients received TAP block with 40ml bupivacaine 0.25% (20 ml each side) before the end of surgery. HR and MABP were measured as baseline, after induction of GA, every 15 min till end of surgery, immediately after recovery, at 2h, 4h, 6h, 8h and 12h postoperatively. Operative time, the duration of anesthesia and Numeric Rating Scale (NRS) at 2h, 4h, 6h, 8h, and 12h after recovery. Time to first analgesic request, total 24h pethidine consumption and side-effects were meas-ured.
Results: HR, MABP, and NRS score showed significant elevation at 6H and 8H postoperatively in group I. First time of analgesic request in group II was prolonged than group I. Pethidine consumption was reduced in group II compared to group I. Postoperative nausea and vomiting (PONV) showed elevation in group I compared to group II.
Conclusion: Postoperative bilateral US-guided TAB block was more effective than US-guided RS block in patients undergoing TAH with prolonged postoperative analgesia, less pethidine consumption, and less PONV.