title: Pain related to robotic cholecystectomy with lower abdominal ports: effect of the bilateral ultrasound-guided split injection technique of rectus sheath block in female patients: A prospective randomised trial.
abstract: BACKGROUND
  Robotic cholecystectomy (RC) using port sites in the lower abdominal area (T12-L1) rather than the upper abdomen has recently been introduced as an alternative procedure for laparoscopic cholecystectomy. Therefore, we investigated the time course of different components of pain and the analgesic effect of the bilateral ultrasound-guided split injection technique for rectus sheath block (sRSB) after RC in female patients.
  
  
  METHODS
  We randomly assigned 40 patients to undergo ultrasound-guided sRSB (RSB group, n = 20) or to not undergo any block (control group, n = 20). Pain was subdivided into 3 components: superficial wound pain, deep abdominal pain, and referred shoulder pain, which were evaluated with a numeric rating scale (from 0 to 10) at baseline (time of awakening) and at 1, 6, 9, and 24 hours postoperatively. Consumption of fentanyl and general satisfaction were also evaluated 1 hour (before discharge from the postanesthesia care unit) and 24 hours postoperatively (end of study).
  
  
  RESULTS
  Superficial wound pain was predominant only at awakening, and after postoperative 1 hour in the control group. Bilateral ultrasound-guided sRSB significantly decreased superficial pain after RC (P < 0.01) and resulted in a better satisfaction score (P < 0.05) 1 hour after RC in the RSB group compared with the control group. The cumulative postoperative consumption of fentanyl at 6, 9, and 24 hours was not significantly different between groups.
  
  
  CONCLUSIONS
  After RC with lower abdominal ports, superficial wound pain predominates over deep intra-abdominal pain and shoulder pain only at the time of awakening. Afterwards, superficial and deep pain decreased to insignificant levels in 6 hours. Bilateral ultrasound-guided sRSB was effective only during the first hour. This limited benefit should be balanced against the time and risks entailed in performing RSB.
authors: Department of Anesthesiology and Pain Medicine Department of Surgery Office of Biostatistics, Ajou University, School of Medicine, Suwon, Korea.
authors: Jin Soo
authors: JS
authors: Kim
authors: Jong Bum
authors: JB
authors: Choi
authors: Sook Young
authors: SY
authors: Lee
authors: Wook Hwan
authors: WH
authors: Kim
authors: Nam Hyun
authors: NH
authors: Baek
authors: Jayoun
authors: J
authors: Kim
authors: Chu Kyung
authors: CK
authors: Park
authors: Yeon Ju
authors: YJ
authors: Lee
authors: Sung Yong
authors: SY
authors: Park
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000187:drug effects*; D018570:Risk Assessment; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D012371:Robotics; D016037:Single-Blind Method; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000779:Anesthetics, Local