Comparative Study Between Ultrasound-Guided Transverse Abdominis Plane Versus Posterior Rectus Sheath Block for Postoperative Analgesia in Midline Laparotomies
DOI:
https://doi.org/10.61919/j74scq69Keywords:
Midline laparotomy, postoperative pain, ultrasound-guided block, posterior rectus sheath block, transversus abdominis plane block, regional anesthesia.Abstract
Background: Postoperative pain following midline laparotomy is severe and contributes to pulmonary impairment, delayed gastrointestinal recovery, and prolonged hospitalization. Although systemic opioids remain the cornerstone of analgesia, their use is limited by adverse effects including respiratory depression, nausea, vomiting, and ileus. Ultrasound-guided fascial plane blocks such as the transversus abdominis plane (TAP) and posterior rectus sheath (PRS) blocks have emerged as effective regional techniques within multimodal analgesia and enhanced recovery after surgery (ERAS) protocols. Objective: To compare the efficacy of ultrasound-guided TAP and PRS blocks for postoperative analgesia in patients undergoing elective midline laparotomy, with primary assessment based on Numeric Rating Scale (NRS) pain scores at 12 hours. Methods: A randomized controlled trial was conducted at Rahman Medical Institute, Peshawar, from 13 April 2025 to 13 July 2025, enrolling 138 patients aged 18–50 years undergoing elective midline laparotomy. Patients were randomized equally to receive either TAP or PRS block under ultrasound guidance in addition to standardized general anesthesia. Postoperative NRS scores were recorded at 2, 6, 12, and 24 hours, and opioid consumption and complications were analyzed. Results: The PRS group reported significantly lower mean NRS scores at all time intervals, with a mean difference of –0.9 (95% CI: –1.24 to –0.56, p < 0.01) at 12 hours. Supplemental opioid use was lower in the PRS group (26.1%) than the TAP group (46.4%), with a relative risk of 0.56 (95% CI: 0.35–0.90). No block-related complications were observed. Conclusion: Ultrasound-guided PRS block provided superior analgesia and opioid-sparing benefits compared to TAP block in midline laparotomy, supporting its integration into ERAS protocols for optimal perioperative pain management.
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Copyright (c) 2025 Danyal Najam, Mohammad Shafiq, Sardar Saud Abbas, Anum Tariq, Shaharyar Khan, Amber Ali (Author)
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