LAUSR

Abstract Background Abdominal operations are very painful procedures which had moderate, severe, or extreme pain. Rectus sheath block has been indicated after midline laparotomy; however, the analgesic effect of landmark technique on postoperative pain was not well investigated. Study objective The objective of this study was to assess the analgesic effectiveness of bilateral rectus sheath block after midline laparotomy using landmark technique using numeric rating scale. Methods A prospective cohort study was conducted from August 03, 2019 to February 25, 2020. Collected data were entered into Epi Info™ version 7.0 and transported to the SPSS version 22. Homogeneity of categorical variables between the groups was analyzed using Chi Square. The Manny-Whitney test was used to compare median pain score and total analgesia consumption between the rectus sheath block group and control group. P-value less than 0.05 were considered statistical significance with a power of 80%. Result There was a statistical significant difference between the groups depending on postoperative pain score measured by numeric rating scale in the first 8 h and total analgesia consumption within the 24 hr post-operatively. The 1st, 2nd, 4th, 6th and 8th postoperative hour numeric rating scale score difference was statistically significant between the two groups. The median 24 hr postoperative tramadol consumption was 175 (165–245) mg and 256(217–411) mg with p-value of 0.002 for the rectus sheath group and control group, respectively. Conclusion and Recommendation For midline laparotomy, doing bilateral rectus sheath block (BRSB) at the end of the operation with 0.25% bupivacaine is a useful postoperative analgesia. Based on these, we recommend the use of bilateral rectus sheath block for patients that undergo midline abdominal incision.