ArticleCureus2026
Rectus Sheath Block Using Bupivacaine Versus No Block for Postoperative Pain Management Following Midline Laparotomy: A Retrospective Comparative Study Using the Visual Analogue Scale.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background Effective postoperative pain management following midline laparotomy is critical to enhance recovery and minimize complications. The rectus sheath block (RSB) with bupivacaine has been proposed as a targeted, opioid-sparing regional analgesic technique. However, data from government hospital settings in India remain scarce. This study evaluated the efficacy of a single-dose RSB with 0.25% bupivacaine compared to standard postoperative analgesia using the Visual Analogue Scale (VAS). Methods A retrospective comparative study was conducted by reviewing records of patients who underwent midline laparotomy at Pandit Dindayal Upadhyay (PDU) Government Hospital, Rajkot, Gujarat, India, from January 2023 to June 2024 (1.5 years). Case records of 60 patients were reviewed and allocated to Group A (n = 30; RSB with 0.25% bupivacaine) or Group B (n = 30; standard care, no block) based on the analgesic technique documented in their operative and postoperative records. VAS pain scores, postoperative analgesia requirement, and rescue analgesia frequency, as recorded in nursing and anesthetic charts at 4, 8, 12, and 24 hours postoperatively, were extracted for analysis. Statistical analysis used the Mann-Whitney U test for VAS data and chi-square/Fisher exact tests for categorical outcomes. Results RSB significantly reduced VAS scores at all time points (median VAS: 3.00 vs. 5.00 at 4 hours; 4.00 vs. 6.50 at 8 hours; 4.00 vs. 7.00 at 12 hours; 5.00 vs. 7.00 at 24 hours; p < 0.001 at all time points). At four hours, none of the RSB patients required analgesia versus 25 (83.3%) in controls (χ² = 42.85, p < 0.001). Rescue analgesia was required four times by 25 (83.3%) controls versus none in the RSB group. Six (20.0%) RSB patients required no rescue analgesia over the 24-hour period. Conclusion Single-dose RSB with bupivacaine provides superior, prolonged postoperative analgesia in midline laparotomy patients, significantly reducing pain scores and analgesic requirements for up to 24 hours. RSB should be considered an integral component of multimodal postoperative pain management protocols, particularly where epidural analgesia is contraindicated or unavailable.
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