Ultrasound-guided rectus sheath blocks after midline laparotomy: an exploratory observational comparative implementation study comparing the analgesic effect between liposomal bupivacaine and continuous ropivacaine.

backgroundOpen abdominal surgery can cause significant postoperative pain, requiring optimal management to facilitate recovery. The use of epidural analgesia has declined, resulting in the increased use of locoregional analgesic techniques as part of a multimodal regime.

methodsThis exploratory observational comparative implementation study aimed to evaluate the postoperative opioid consumption and analgesic outcome following the clinical implementation of liposomal bupivacaine in ultrasound-guided rectus sheath blocks, compared to a historical cohort receiving continuous ropivacaine after midline laparotomy. Opioid consumption and pain scores in the first 72 h postoperatively were respectively the primary and secondary outcomes.

resultsTwenty-two patients were included in each group. A total of 35 patients had opioid consumption noted for the first 72 h. Mean opioid consumption was significantly higher in the liposomal bupivacaine group, with mean difference of 46.4 mg morphine milligrams equivalents (95% CI [11.1 mg, 81.7 mg]). Mean pain scores in both groups were low during the first 72 postoperative hours.

conclusionsAlthough ultrasound-guided rectus sheath blocks with LB were associated with higher opioid consumption up to 72 h postoperatively after midline laparotomy compared to continuous rectus sheath blocks with ropivacaine, both groups exhibited low opioid consumption as well as similarly low pain scores.