Comparison of analgesic efficacy of ropivacaine and bupivacaine for ultrasound-guided rectus sheath block after upper abdominal surgery in adults

Abstract

Background: Ultrasound (US)-guided rectus sheath block (RSB) is increasingly being used as a part of multimodal analgesia for abdominal surgeries with midline incisions. Both ropivacaine and bupivacaine are commonly used for RSB, with varied duration of analgesia that remains an area of clinical interest. Aims and Objectives: To compare the post-operative analgesic efficacy of ropivacaine and bupivacaine when used for US-guided RSB in terms of duration of post-operative analgesia (Primary outcome). Materials and Methods: For this randomized, double-blind study, 62 adult patients were randomized into two groups to receive either 0.25% ropivacaine (Group R, n=31) or 0.25% bupivacaine (Group B, n=31) for US-guided RSB for their upper abdominal surgery with midline incision under general anesthesia. Each patient received 15 mL of study drug on either side of the rectus sheath. Post-operative pain was assessed using the Visual Analog Scale (VAS). Rescue analgesia was provided with intravenous fentanyl when VAS >3. Time to first rescue analgesic, total fentanyl consumption in 24 h, and adverse events were recorded. Results: Considerably longer post-operative analgesia was noted in patients receiving ropivacaine compared with bupivacaine (mean, 325 vs. 141 min, and median, 360 vs. 120 min, respectively) for US-guided RSB. Considerably less amount of rescue analgesics were consumed by patients receiving ropivacaine compared with bupivacaine for RSB (mean, 28.23 vs. 37.90 mcg fentanyl, respectively). Adverse events were comparable. Conclusion: Ropivacaine provides significantly longer post-operative analgesia over bupivacaine during the use of US-guided RSB in adult patients undergoing upper abdominal surgery with midline incision.