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Rectus Sheath Block in Abdominal Surgery: A Systematic Review with Meta-Analysis Cover

Rectus Sheath Block in Abdominal Surgery: A Systematic Review with Meta-Analysis

Open Access
|Apr 2023

Figures & Tables

Figure 1.

PRISMA diagram
PRISMA diagram

Figure 2.

Anaesthetics and opioids consumption (in morphine equivalents, mg/kg).
Anaesthetics and opioids consumption (in morphine equivalents, mg/kg).

Figure 3.

Pain intensity (out of 10).
Pain intensity (out of 10).

Figure 4.

Time to first opioid/analgesic request (min).
Time to first opioid/analgesic request (min).

Characteristics of included studies

Author, citationCountryStudy designStudy goalsAgeNumber of patients: total (intervention/control)GroupSurgeryGeneral anesthesiaASALocal anesthetics, volume and concentrationAdjuvants to local anesthetics
Cho et al., 2018South KoreaRCTPrimary: post-operative VNRS pain scores, total number of rescue analgesics used in 48 hours after the operation21-60 Mean (SD): Intervention –39.6(9.8) Control –41.7(11.3)60 (30/30)Intervention: ultrasound-guided RSB Control: no blockGynecologic laparoscopic surgeryYesI-II7.5 mL 0.25% ropi-vacaine bilaterallyFentanyl, ketorolac
Cowlishaw et al., 2017-RCTAnalgesic and antiemetic consumption, pain scores (VAS), nausea, vomiting, and satisfaction54-5688 (29/29/30) - (SC/PRS/TAP)Intervention: TAP – transversus abdominis plane catheter, PRS – posterior rectus sheath catheter, SC – subcutaneous catheterMid line Laparotomy surgeryNo 18 mL 0.5% ropivacaine via catheterDexamethasone, Metoclopramide, Paracetamol, NSAIDs
Kartalov et al., 2017North MacedoniaRCTPrimary: VAS pain scores, total morphine dose over 24 hoursMean (SD): Intervention –41.3(15.8) Control –42.4(14.7)60 (30/30)Intervention: general anesthesia with RSB Control: no blockUmbilical hernia repair surgeryYesI-II20 mL 0.25% bupi-vacaine bilaterallyParacetamol, morphine IV
Kauffman et al., 2020USARCTPrimary: 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 RSBSingle-incision laparoscopic cholecystectomy surgery (gail-bladder removal)YesI-II0.5 mL/kg 0.2% ropivacaine hydrochloride bilaterally (total 1 mL/kg, total maximum dose 10 mL)Ondansetron IV, dexamethasone, glycopyrrolate
Li et al., 2019ChinaRCTPrimary: 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 block46-70 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)YesI-IIIGroup 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 analgesicsDexmedetomidine, sufentanyl
Murouchi et al., 2015USARCTConcentration changes of Ropivacaine and analgesic effects18-8522 (11/11)Intervention: RSB Control: TAPBlaparoscopic ovarian surgeryYesI-II30mL 0.5% ropivacaine bilaterally, 15mL per sidedroperidol, acetaminophen
Xu et al., 2018ChinaRCTPrimary: effectiveness and safety75-7760 (30/30) -(R+D/R)Intervention: R+D (10mL0.25% ropivacaine + 0.5 μg/kg dexmedetomidine); R (10 mL 0.25% ropivacaine)Emergency abdominal surgeryPatient-controlled intravenous analgesia (PCIA)II-III10 mL 0.25% ropivacaine, + 0.5 μg/kg dexmedetomidine bilaterallySufentanil, Cardiovascular medications
Yentis et al., 1999UKRCTPain scores, morphine requirements32-7137(21/16)Intervention: midline incisions Control: transverse incisionsabdominal gynecological surgeryYesI-IIUp to 60 ml bupivacaine 0.25%adrenaline 1:400 000

Jadad Scale

Study or subgroupWas 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 2018110013
Cowlishaw 2017111115
Kartalov 2017101002
Kauffman 2020101114
Li 2019111115
Murouchi 2015100001
Xu 2018111014
Yentis 1999111003
DOI: https://doi.org/10.2478/rjaic-2023-0006 | Journal eISSN: 2502-0307 | Journal ISSN: 2392-7518
Language: English
Page range: 43 - 50
Published on: Apr 20, 2023
Published by: Sciendo
In partnership with: Paradigm Publishing Services
Publication frequency: 2 issues per year

© 2023 Yerkin Abdildin, Karina Tapinova, Azamat Salamat, Ramazan Shaimakhanov, Alisher Aitbayev, Dmitriy Viderman, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.