The effect of ultrasound guided rectus sheath block on postoperative pain and opioid consumption. A review and implication for nursing clinical practice

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ABSTRACT

Background: recent randomized clinical trials (RCT) evidence showed that ultrasound guided regional techniques or nervous blocks can offer an effective component of multimodal postoperative analgesia after a variety of surgeries with limited side-effects. The aim of this review is to evaluate and consolidate scientific evidence of rectus sheath block effect on postoperative pain and postoperative opioid consumption.
Methods: this study presents a literature review, following the systematic review process as outlined in the PRISMA flow chart. The search strategy has included 7 electronic databases: Medline, Cochrane, Scopus, Embase, Web of Science, CINAHL, ESCI.
Results: 9 studies were included (8 experimental studies and 1 prospective study with 3 comparison groups) (Cohen’s K, 1). Rectus Sheath block has an immediate effect and offers better analgesic coverage at least in the first 6 hours after surgery (77.77 % of the included studies). Postoperative opioid consumption was lower in RSB group for 55.55 % of the included studies.
Significantly lower consumption of morphine was observed one hour after surgery (p <0.001) (55.55 % of the included studies). The average 24-hour morphine consumption in RSB group was lower and showed statistically significant (44.44% of the included studies). Conclusions: ultrasound-guided rectus sheath block was found effective in reducing pain scores and opioid consumption compared to general anesthesia alone. High quality evidence is needed before we can be confident of how effective the block, 48 and 72 hours after abdominal surgery for this population are. 

Keywords: Rectus muscle of abdomen, nerve block, abdominal pain, opioid, surgery.