Bilateral Rectal Sheath Block reduces complications after cytoreductive surgery: Study

A recent study found that Bilateral Rectal Sheath Block (BRSB) is safe and effective procedure to provide short-term postoperative analgesia, and reduce the incidence of postoperative complications in cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The study was published in the Journal, 'BMC Anesthesiology', 2020.

Radical cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) under General Anesthesia (GA) is a standard for the treatment of peritoneal cancer. But GA can itself cause certain post operative complications and ultrasound-guided bilateral rectus sheath block (BRSB) has been found to ameliorate postoperative pain and reduce the consumption of morphine. Researchers from the Department of Anesthesiology, Beijing Shijitan Hospital Capital Medical University, China conducted a study to examine the effects of bilateral rectus sheath block (BRSB) in CRS combined with HIPEC.

After collecting necessary Patient information and anesthesia-related indicators from the electronic medical record (EMR) system a total of 178 patients undergoing CRS/HIPEC were included in the study. All the participants were divided into two groups called the G group (general anesthesia) and the GR group (RSB combined with general anesthesia). Patients in the GR group received 0.375% ropivacaine for BRSB before surgery. The primary outcomes included the total amount of remifentanil and rocuronium, the total consumption of dezocine after surgery, the visual analogue scale (VAS) score and the patient-controlled intravenous analgesia (PCIA) input dose at 1 h (T6), 6 h (T7), 12 h (T8), 24 h (T9) and 48 h (T10) after surgery. Other outcomes, such as patient demographic data, the intraoperative heart rate (HR) and mean arterial pressure (MAP), and postoperative complications were also included.

The key findings of the study were:

• Compared with the G group, the GR group showed a shorter time to tracheal extubation (P < 0.05), a decreased total amount of remifentanil and rocuronium (P < 0.05), and a reduced VAS score, PCIA input dose and number of PCIA boluses at 1 h, 6 h and 12 h after surgery (P < 0.05).
• However, at 24 h and 48 h after surgery, there were no differences in the VAS score of pain at rest or during motion between the two groups (P > 0.05).
• Moreover, the incidence of hypertension, emergence agitation, delayed recovery, hypercapnia, and nausea and vomiting was lower in the GR group than in the G group (P < 0.05).
• There were no differences in the changes in MAP and HR during the surgery between the two groups (P > 0.05).
• No complications associated with nerve block occurred.

Thus, the researchers concluded that BRSB could provide short-term postoperative analgesia, reduce perioperative opioid consumption and reduce the incidence of postoperative complications in CRS/HIPEC. 

For further reading, click the following link: https://doi.org/10.1186/s12871-020-01099-3