title: Ultrasound-guided rectus sheath and transversus abdominis plane blocks for perioperative analgesia in upper abdominal surgery: A randomized controlled study.
abstract: BACKGROUND
  Regional anesthetic techniques can be used to alleviate postoperative pain in patients undergoing major upper abdominal surgery. Our aim was to evaluate the efficacy of bilateral ultrasound (US)-guided rectus sheath (RS) and transversus abdominis plane (TAP) blocks for better perioperative analgesia.
  
  
  METHODS
  It is a prospective, observer-blinded, randomized clinical study. 40 eligible patients undergoing elective liver resection or Whipple procedure were included. All patients received a standardized anesthetic technique. Group 1 (n = 20) received preincisional US-guided bilateral RS and TAP blocks using 20 ml volume of bupivacaine 0.25% for each, and group 2 (n = 20) received local wound infiltration at end of surgery with 40 ml of bupivacaine 0.25%. A standardized postoperative analgesic regimen composed of intravenous paracetamol and a morphine patient-controlled analgesia (PCA). The use of intraoperative fentanyl and recovery room morphine boluses, PCA-administered morphine, pain scores as well as number of patients' experienced postoperative nausea and vomiting in the ward at 6 and 24 h were recorded.
  
  
  RESULTS
  Group 1 patients received a significantly lower cumulative intraoperative fentanyl, significantly lesser boluses of morphine in postanesthesia care unit, as well, significantly lower cumulative 24 h postoperative morphine dosage than the group 2 patients. Pain visual analog scale scores were significantly lower at both 6 and 24 h postoperatively in TAP group when compared with the no-TAP group. There were no complications related to the TAP block procedures. No signs or symptoms of local anesthetic systemic toxicity were detected.
  
  
  CONCLUSIONS
  The combination of bilateral US-guided RS and TAP blocks provides excellent perioperative analgesia for major upper abdominal surgery.
authors.affiliation: Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Department of Anesthesia, Faculty of Medicine, King Fahd Specialist Hospital, Dammam, Saudi Arabia.
authors.forename: Khaled
authors.initials: K
authors.lastname: Abdelsalam
authors.affiliation: Department of Anesthesia, Faculty of Medicine, King Fahd Specialist Hospital, Dammam, Saudi Arabia.
authors.forename: O W
authors.initials: OW
authors.lastname: Mohamdin
keywords: Abdominal surgery; analgesia; rectus sheath; transversus abdominis plane block; ultrasound