Tag Archives: opioid

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

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.

Ultrasound-guided thoracic pectoral and serratus plane blocks: new approaches to reducing postoperative pain

ABSTRACT

Background: pectoralis nerve and serratus plane blocks (PECS) are newer ultrasound guided regional anesthesia techniques of the thorax. Aim: evaluate and consolidate scientific evidence of ultrasound-guided thoracic PECS or modified PECS block-serratus anterior plane block effect on postoperative pain in comparison with other comparison intervention. Methods: we searched 8 electronic databases: Medline, Cochrane, Scopus, Embase, Web of Science, CINAHL, ESCI and ILISI. Three of the authors independently selected trials, assessed the risk of bias, and extracted data. Results: final analysis included thirteen trials. When the PECS block is effective, an optimal duration of analgesia has been reported in the first 24 hours after surgery. PECS block (or its modifications) has a significant pain effect in the postoperative period. However, paravertebral block (PVB) has slightly better efficacy at 18 h and 24 h (p = 0.008 and <0.001 respectively) compared with PECS block. Conclusions: the PECS block produced excellent analgesia, often if combined with general anesthesia for breast surgery. PECS block could be recommended as an alternative to intravenous normal anesthesia in certain breast surgeries for pain postoperative management.

Key words: thoracic surgery, pectoral blocks, serratus plane block, postoperative pain, regional anesthesia, opioid.

Received: September 10, 2018

Accepted: October 10, 2018

DOI: 10.19190/PNM2018.1_ra10