Comparison of spread of local anaesthetic mixture and their analgesic efficacy between two point and four point rectus sheath block in cancer patients undergoing midline laparotomy surgeries

BACKGROUND: Rectus sheath block (RSB) provides excellent analgesia for midline abdominal procedures. The lacuna in the literature in comparing 2points with 4points RSB in conjunction with the spread of drugs and its analgesic efficacy during intraoperative and postoperative period is being addressed in this study.

AIM: To compare the efficacy of analgesia and drug spread between the two techniques of RSB in midline laparotomy surgeries.

METHODOLOGY: patients were divided into group-1(n=33) receiving 2-point RSB and group-2(n=33) receiving 4-point RSB using 0.25% ropivacaine with 4mg dexamethasone. People willing to give written informed consent, weighing >50kg and aged >18years assessed under ASA 1 to 4 are included in this study. Outcomes such as spread of local anaesthetics between 2 techniques after 10min of block procedure and their analgesic efficacy intraoperatively based on vitals recorded every 10min for first 1hour and thereafter every 30min once till the end of surgery, requirement of rescue analgesics (epidural bolus and opioids) and postoperatively based on VAS score recorded at 0,1,2, 4,6,8,12 hrs and rescue analgesics used were noted.

RATIONAL FOR THE STUDY:

Even though there are many literatures stating the efficacy of analgesia with rectus sheath block none of them explained the spread of local anaesthetics in posterior rectus sheath plane. There is a lacuna in the literature in comparing the spread of local anaesthetics between 2points and 4points RSB and its efficacy with respect to intraop and post op analgesia.