Abstract

Epidural analgesia remains the gold standard for pain control for abdominal surgical procedures, yet have many potential side effects, risks and limitations. The idea of oblique subcostal transversus abdominis plane block (OSTAPB) and rectus sheath block (RSB) is to anesthetize part of or the entire abdominal wall instead of using intrathecal or epidural techniques, especially in the presence of sepsis and coagulopathy.
Materials and methods: 60 patients scheduled for midline incision abdominal surgeries were randomly assigned to receive ultrasound-guided RSB and OSTAPB blocks with 20ml 0.25% bupivacaine and 40ml 0.25% bupivacaine respectively on each side after induction with general anaesthesia and before start of surgery. Preoperative and intraoperative parameters, plus intraoperative and postoperative cumulative analgesic consumption were recorded. Both groups received intravenous paracetamol 15mg/kg 8 hourly. Postoperative pain severity was assessed using 10cm VAS score and time to request for rescue analgesia, total analgesic consumption in 24 h were recorded.
Results: Patients in the OSTAPB group had more stable hemodynamics and consumed statistically significant less opioid in comparison to RSB group either intraoperatively or postoperatively. Mean VAS scores were statistically significant less in OSTAPB group than in the RSB group at 0, 2, 6, 12, and 24 h postoperatively.  More patients’ satisfaction was reported in the OSTAPB Group.
Conclusion: Ultrasound-guided RSB and OSTAPB block is effective pain management technique for midline laparotomies in scenarios where epidural is contraindicated, has failed or in case of unexpected change in surgical plan and in patients with compromised physiology