EFFECT OF THE RECTUS SHEATH BLOCK ON HEMODYNAMIC CHANGES IN TOTAL ABDOMINAL HYSTERECTOMY AS A PART OF MULTIMODAL ANESTESIA

Goran Mitreski; Marija Sholjakova; Nevenka Laban Gucheva; Pranvera Izairi; Valentina Mitreska

Goran Mitreski Specialized Hospital for Gynecology and Obstetrics "Mother Teresa" Skopje, Faculty of Medical Sciences, Goce Delcev University in Stip, North Macedonia
Marija Sholjakova Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Nevenka Laban Gucheva Faculty of Medical Sciences, Goce Delcev University in Stip, North Macedonia
Pranvera Izairi Specialized Hospital for Gynecology and Obstetrics "Mother Teresa" Skopje, Faculty of Medical Sciences, State University of Tetova North Macedonia
Valentina Mitreska Public Health Institution "Health Center" Skopje, North Macedonia

Abstract

Background: Total abdominal hysterectomy (TAH) is associated with substantial postoperative pain and discomfort. Rectus sheath block (RSB) is used to block the sensory nerves of the anterior abdominal wall and thereby contribute to pain relief after lower abdominal surgeries. Aim of Study: The aim of this study is to evaluate the effect of bilateral Ultrasound (US)-guided RSB on hemodynamic changes after TAH. Patients and Methods: This prospective randomized study was carried out on 10 females, ASA I or II, presented for elective TAH under general anesthesia (GA) and randomly classified into 2 equal groups R and C of 5 patients each; patients in Group R received RSB with 40 ml ropivacaine 0.375% (20ml each side) before surgery and standard endotracheal anesthesia and patients in Group C received only standard general endotracheal anesthesia. Mean arterial Blood pressure (MAP) and Heart rate (HR) were measured as baseline, after induction of GA, every 15 min till end of surgery, immediately after recovery, at 6h, 12h and 24 h postoperatively. Conclusion: Patients in group R with bilateral US-guided RSB and standard general anesthesia had higher values of systolic and diastolic blood pressure, mean arterial pressure, and heart rate at the start and during the hysterectomy, compared to the control group C, which had a calm hemodynamic initial course. Postoperative measurements showed stable parameters, with a decrease in hemodynamic values in group R compared to group C, demonstrating an approximation to the values of group C.

Key Words: hemodynamic changes, Rectus Sheath Block, Total Abdominal Hysterectomy

References

1. Bhatia A, Buvanendran A. Anesthesia and postoperative pain control—multimodal anesthesia protocol. Journal of Spine Surgery. 2019 Sep;5(S2):S160–5.
2. Schwenk ES, Mariano ER. Designing the ideal perioperative pain management plan starts with multimodal analgesia. Korean Journal of Anesthesiology [Internet]. 2018;71(5):345–52. Available from: https://ekja.org/journal/view.php?number=847
3.Willschke H, Bösenberg A, Marhofer P, et al. Ultrasonography-guided rectus sheath block in paediatric anaesthesia--a new approach to an old technique. Br J Anaesth. 2006;97(2):244–249. doi:10.1093/bja/ael143
4. Yu S, Wen Y, Lin J, Yang J, He Y, Zuo Y. Combined rectus sheath block with transverse abdominis plane block by one puncture for analgesia after laparoscopic upper abdominal surgery: a randomized controlled prospective study. BMC Anesthesiol. 2024;24(1):58. doi:10.1186/s12871-024- 02444-6
5. Kim WJ, Mun JY, Kim HJ, et al. Surgical rectus sheath block combined with multimodal pain management reduces postoperative pain and analgesic requirement after single-incision laparoscopic appendectomy: a retrospective study. Int J Colorectal Dis. 2021;36(1):75–82. doi:10.1007/s00384- 020-03725-5
6. Zhu JL, Wang XT, Gong J, Sun HB, Zhao XQ, Gao W. The combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy: a randomized trial. BMC Anesthesiol. 2020;20(1):22. doi:10.1186/s12871-020-0941-1 https://doi.org/10.2147/JPR.S460367 DovePress 2162 Journal of Pain Research 2024
7. Bhandoria GP, Bhandarkar P, Ahuja V, Maheshwari A, Sekhon RK, Gultekin M, et al. Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice. Int J Gynecol Cancer [Internet]. 2020;30(10):1471–8. Available from: http://dx.doi.org/10.1136/ijgc-2020-001683
8. Elbagoury MM, Okab MSM, Amin MDS, Eltatawy HI. The effect of ultrasound guided rectus sheath block versus transversus abdominis plane block for pain relief after total abdominal hysterectomy [Internet]. Ekb.eg. [cited 2025 Jun 24]. Available from: https://mjcu.journals.ekb.eg/article_59339_e559fcbcb7c5caac33ac452df2d88bf8.pdf
9. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth [Internet]. 2005;94(1):7–17. Available from: http://dx.doi.org/10.1093/bja/aei002
10. Crosbie EJ, Massiah NS, Achiampong JY, Dolling S, Slade RJ. The surgical rectus sheath block for post-operative analgesia: a modern approach to an established technique. Eur J Obstet Gynecol Reprod Biol [Internet]. 2012;160(2):196–200. Available from: http://dx.doi.org/10.1016/j.ejogrb.2011.10.015
11. Gray AT. Ultrasound-guided regional anesthesia: current state of the art. Anesthesiology [Internet]. 2006;104(2):368–73, discussion 5A. Available from: http://dx.doi.org/10.1097/00000542-200602000-00024
12. de Jose Maria B, Götzens V, Mabrok M. Ultrasound-guided umbilical nerve block in children: a brief description of a new approach. Paediatr Anaesth [Internet]. 2007;17(1):44–50. Available from:http://dx.doi.org/10.1111/j.1460-9592.2006.02025.x
13. Finnerty O, Carney J, McDonnell JG. Trunk blocks for abdominal surgery. Anaesthesia [Internet]. 2010;65 Suppl 1:76–83. Available from: http://dx.doi.org/10.1111/j.1365-2044.2009.06203.x
14. Aslam M, Bangash LR, Zafar M, Arshad M, Ajmal MO, Khalid S. Effect of propofol concentration on mean arterial pressure and success of laryngeal mask airway insertion: A quasi experimental study [Internet]. Jaimc.org. [cited 2025 Jun 27]. Available from: https://jaimc.org/wp-content/uploads/2025/05/Vol-22-Issue-04-Final-25-30.pdf
15. Robinson BJ, Buyck HC, Galletly DC. Effect of propofol on heart rate, arterial pressure and digital plethysmograph variability. Br J Anaesth [Internet].
1994;73(2):167–73. Available from: http://dx.doi.org/10.1093/bja/73.2.167
16. Shirasaka T, Yano T, Kunitake T, Tsuneyoshi I. High-dose remifentanil increases blood pressure and heart rate mediated by sympatho-activation in conscious rats. J Anesth [Internet]. 2013;27(3):325–32. Available from: http://dx.doi.org/10.1007/s00540-012-1515-2
17. Watterson LM, Morris RW, Westhorpe RN, Williamson JA. Crisis management during anaesthesia: bradycardia. Qual Saf Health Care [Internet]. 2005 [cited 2025 Jun 27];14(3):e9. Available from: https://qualitysafety.bmj.com/content/14/3/e9
18. Mumtaz S, Mir J, Chan V, Akram A. Successful resuscitation of ropivicaine-induced cardiac arrest after popliteal nerve block. Chest [Internet]. 2020;158(4):A218. Available from: http://dx.doi.org/10.1016/j.chest.2020.08.224