Rectus Sheath Block in Abdominal Surgery: A Systematic Review with Meta-Analysis
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20 avr. 2023
À propos de cet article
Catégorie d'article: Review
Publié en ligne: 20 avr. 2023
Pages: 43 - 50
DOI: https://doi.org/10.2478/rjaic-2023-0006
Mots clés
© 2023 Yerkin Abdildin et al., published by sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
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Characteristics of included studies
| Author, citation | Country | Study design | Study goals | Age | Number of patients: total (intervention/control) | Group | Surgery | General anesthesia | ASA | Local anesthetics, volume and concentration | Adjuvants to local anesthetics |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Cho et al., 2018 | South Korea | RCT | Primary: post-operative VNRS pain scores, total number of rescue analgesics used in 48 hours after the operation | 21-60 Mean (SD): Intervention –39.6(9.8) Control –41.7(11.3) | 60 (30/30) | Intervention: ultrasound-guided RSB Control: no block | Gynecologic laparoscopic surgery | Yes | I-II | 7.5 mL 0.25% ropi-vacaine bilaterally | Fentanyl, ketorolac |
| Cowlishaw et al., 2017 | - | RCT | Analgesic and antiemetic consumption, pain scores (VAS), nausea, vomiting, and satisfaction | 54-56 | 88 (29/29/30) - (SC/PRS/TAP) | Intervention: TAP – transversus abdominis plane catheter, PRS – posterior rectus sheath catheter, SC – subcutaneous catheter | Mid line Laparotomy surgery | No | 18 mL 0.5% ropivacaine via catheter | Dexamethasone, Metoclopramide, Paracetamol, NSAIDs | |
| Kartalov et al., 2017 | North Macedonia | RCT | Primary: VAS pain scores, total morphine dose over 24 hours | Mean (SD): Intervention –41.3(15.8) Control –42.4(14.7) | 60 (30/30) | Intervention: general anesthesia with RSB Control: no block | Umbilical hernia repair surgery | Yes | I-II | 20 mL 0.25% bupi-vacaine bilaterally | Paracetamol, morphine IV |
| Kauffman et al., 2020 | USA | RCT | Primary: pain score 60 minutes after the PACU arrival Secondary: pain (PACU), length of PACU stay, outpatient pain scores, outpatient opioid use, adverse events. | 10-21 Total: 15.3(3.1), control: 15.8(1.6), intervention: 14.83(4.0) | 48 (24/24) | Intervention: laparoscopic-guided RSB. Control: trans-incisional RSB | Single-incision laparoscopic cholecystectomy surgery (gail-bladder removal) | Yes | I-II | 0.5 mL/kg 0.2% ropivacaine hydrochloride bilaterally (total 1 mL/kg, total maximum dose 10 mL) | Ondansetron IV, dexamethasone, glycopyrrolate |
| Li et al., 2019 | China | RCT | Primary: incidence of positive hemodynamic response at incision, incidence of moderate pain postoperatively Secondary: intraoperative sufentanyl, time to eye opening, time to extubation, time to oxycodone request, duration of sensory block | 46-70 Mean (SD):Group B – 58.0 (8.3), Group C – 56.4 (8.6), Group D – 58.7 (7.1), Group BD – 57.1 (8.3) | 85 (66/19) 1 control group: 19 (Group C) 3 intervention groups: 22 (Group B), 21 (Group D) and 23 (Group BD) | Intervention: ultrasound-guided RSB (Group B), dexmedetomidine infusion (Group D), both RSB and dexmedetomidine (Group BD) Control: nothing (Group C) | Open gastrectomy surgery (stomach removal) | Yes | I-III | Group B: 20 mL 0.375% ropivacaine diluted in 0.9% saline bilaterally only Group D: initial dose 0.6 μg/kg dexmedetomidine followed by continuous infusion 0.2 μg/kg/h during surgery then followed by 10 μg sufentanyl Group BD: combination of Group B analgesics first followed by Group D analgesics | Dexmedetomidine, sufentanyl |
| Murouchi et al., 2015 | USA | RCT | Concentration changes of Ropivacaine and analgesic effects | 18-85 | 22 (11/11) | Intervention: RSB Control: TAPB | laparoscopic ovarian surgery | Yes | I-II | 30mL 0.5% ropivacaine bilaterally, 15mL per side | droperidol, acetaminophen |
| Xu et al., 2018 | China | RCT | Primary: effectiveness and safety | 75-77 | 60 (30/30) -(R+D/R) | Intervention: R+D (10mL0.25% ropivacaine + 0.5 μg/kg dexmedetomidine); R (10 mL 0.25% ropivacaine) | Emergency abdominal surgery | Patient-controlled intravenous analgesia (PCIA) | II-III | 10 mL 0.25% ropivacaine, + 0.5 μg/kg dexmedetomidine bilaterally | Sufentanil, Cardiovascular medications |
| Yentis et al., 1999 | UK | RCT | Pain scores, morphine requirements | 32-71 | 37(21/16) | Intervention: midline incisions Control: transverse incisions | abdominal gynecological surgery | Yes | I-II | Up to 60 ml bupivacaine 0.25% | adrenaline 1:400 000 |
Jadad Scale
| Study or subgroup | Was this study described as randomized? | Was the method used to generate the sequence of randomization appropriate and described? | Was the study described as double-blind? | Was the method of double blind appropriate and described? | Was there a description of withdraw and dropouts? | Total score |
|---|---|---|---|---|---|---|
| Cho 2018 | 1 | 1 | 0 | 0 | 1 | 3 |
| Cowlishaw 2017 | 1 | 1 | 1 | 1 | 1 | 5 |
| Kartalov 2017 | 1 | 0 | 1 | 0 | 0 | 2 |
| Kauffman 2020 | 1 | 0 | 1 | 1 | 1 | 4 |
| Li 2019 | 1 | 1 | 1 | 1 | 1 | 5 |
| Murouchi 2015 | 1 | 0 | 0 | 0 | 0 | 1 |
| Xu 2018 | 1 | 1 | 1 | 0 | 1 | 4 |
| Yentis 1999 | 1 | 1 | 1 | 0 | 0 | 3 |