Efficiency of Retromuscular Rectus Sheath Block with Continuous Bupivacaine Catheter Infusion After Open Gastrectomy

Severe pain is a major problem in the early postoperative period after open major upper gastrointestinal surgery. This study aimed to assess the efficiency of rectus sheath block with catheters placed through open access into the retromuscular space in providing effective pain relief. A prospective study was done at Rīga East University Hospital, Latvia. Thirty-nine patients with open gastrectomy were allocated into two groups: 21 patients in the block group and 18 patients in the control group. In the block group, at the end of the operation, two catheters were inserted into the retromuscular plane under the m. rectus abdominis through the open access (using a specially invented technique). After surgery, patients in the block group received continuous 0.125% (10–12 mg/h) bupivacaine infusion through rectus sheath catheters for 72 hours. Patients in the control group received standard postoperative analgaesia. The results showed that postoperative pain at rest was significantly lower in the Block group than in the control group at 48-hour and 72-hour intervals after surgery. Pain on movement in the block group was significantly lower than that in the control group at all postoperative times: at 24, 48, and 72 hours. The median fentanyl requirement range in the postoperative period was significantly lower in the block group (0.5 (0–1.25) mg) than in the control group (2.0 (1.0–3.25) mg (p = 0.001)). Continuous retromuscular rectus sheath infiltration of 0.125% bupivacaine through a rectus sheath catheter after open gastrectomy provides effective postoperative analgaesia in the early postoperative period and significantly reduces opioid consumption.