Effect of ultrasonography-guded rectus sheath block on postoperative analgesia in gynecologic surgery

Purpose: In our study we aimed to evaluate the effects of ultrasonography-guided rectus sheath block with levobupivacain on peroperative sevoflurane and postoperative tramadol consumption in gynecologic surgery with pfannenstiel incision.Materials and Method: After approval of Turkish Republic Ministry of Health Ethics Committee and patient consent,our study was carried out in the Anaesthesiology and Reanimation Clinics of Çukurova University,Faculty of Medicine, Balcalı Hospital. In this study; 75 patients aged 20-70, ASA I-II,who are undergoing myomectomy and hysterectomy surgery with pfannenstiel incision in Gynecologic Clinics were included.Patients randomly divided into three groups.In group I (n=25) patients after general anaesthesia induction and entubation, preoperatively ultrasonography ? guided rectus sheath block with 0.25 %, 0.2 ml/kg levobupivacain in saline was performed. In group II patients (n=25) ,peroperatively rectus sheath block with 0.25%, 0.2 ml/kg levobupivacain in saline was performed from the area of surgery at incision side.In group III patients (n=25) 2 mg/kg i.v. tramadol was performed 30 minutes before the end of surgery .For both three groups Patient controlled analgesia (PCA) device was set with 0.2 mg/kg bolus dose and 10 minutes lock period.Peroperatively inspired sevoflurane concentration (%), peroperatively and postoperatively systolic and diastolicblood pressures, heart rates and oxygen saturations of each group were measured and reorded. Also postoperatively total PCA tramadol consumption, VAS pain scores, additional analgesic requirment, defecation time and side effects like nausea and vomitting were recorded.Findings: The demographic characteristics, operation periods and hemodynamic parameters of groups were similar. Peroperatively inspired sevoflurane concentration (%) was significantly lower in group I patients than group II and group III patients (p=0.0001), and VAS similuar in group II and group III patients (p>0.05).Postoperative systolic and diastolic blood pressures, heart rates were in hemodynamic lines clinically. Postoperative 24-hour cumulative tramadol consumption were found smilar in group I and group II patients (p>0.05) and lower than group III patiens (p=0.0001). Also VAS pain score was lower in group I patients at postperative 30 minutes, 1., 2., 4. hours (p=0.021) (p=0.020) (p=0.045) (p=0.044), than group II and group III patients. In group II and III patients VAS pain scores were similar (p>0.05). Incidence of side effects nausea, vomitting and additional analgesic requirment were not significantly different in three groups statistically (p>0.05). In group I; 5 patients, in group II; 1 patients have defecation and that was statistically significant (p>0.05).Results: Preoperative ultrasonography - guided rectus sheath block with levobupivacain reduce peroperatively inspired sevoflurane concentration (%) and postoperative tramadol requirment,provide efficient analgesia don?t effect hemodynamic parameters significantly and causes no serious side effects.Key words: Gynecologic surgery, Patient Controlled Analgesia, Levobupivacain, Rectus Sheath Block, Sevofluran, Ultrasonography