Ultrasound-guided rectus sheath block versus transversus abdominis plane block for post-operative analgesia in laparoscopic hernia surgery – A prospective randomized double blind study

Abstract

Background: Ultrasound (US)-guided rectus sheath (RS) block and transversus abdominis plane (TAP) block are being utilized to achieve post-operative analgesia during midline and lower abdominal surgeries. Dilemma exists regarding the superiority of any specific block over the other. Aims and Objectives: This study compared US-guided RS and TAP blocks in terms of duration of stay in the post-anesthesia care unit (PACU), post-operative analgesia and adverse events after laparoscopic hernia surgery. Materials and Methods: Eighty-four patients scheduled for laparoscopic hernia surgery were randomly allocated into two groups to receive either TAP block or RS block, both blocks were given under US-guidance at pre-extubation stage using 15 mL 0.25% bupivacaine with 8 mg dexamethasone. Duration of stay at PACU, post-operative visual analog scale (VAS) score, rescue analgesic consumption, and hemodynamics (heart rate, mean arterial pressure) were noted. Results: Average stay at PACU was lower in patients receiving TAP block compared with those receiving RS block (Mean, 1.38 vs. 2.41 days, respectively). The magnitude of difference was approximately 24 h less in patients receiving TAP block over RS block. Patients receiving TAP block experienced about 0.7 unit lower VAS score at 12th h of post-operative period. About 0.5 units lesser amount of rescue analgesic was received by those patients receiving TAP block, the difference being statistically significant. Conclusion: US-guided TAP block is a better alternative to US-guided RS block in terms of shorter duration of PACU stay, improved post-operative pain score and less requirement of rescue analgesia in the post-operative period after laparoscopic hernia surgery.