The investigation of the effect of the rectus sheath block implemented with levobupivakain on the postoperative analgesia accompanied by preoperative ultrasonography in the laparotomies done with transverse incision in pediatric surgery

Purpose: In our study, we investigated the effects of the rectus sheath block implemented with levobupivakain on the consumptions of intra-operative sevoflurane and post-operative analgesic.Materials and Method: Our study was carried out in the Anaesthesiology and Reanimation Clinics of Çukurova University, Faculty of Medicine, Balcalı Hospital after the necessary permissions and approvals had been taken from the parents and Turkish Republic Ministry of Health Ethics Committee. 40 patients whose ages were between 3-18 and from the group of ASA I-II and who would be implemented abdomen surgery through transverse incision in the Pediatrics Surgery Clinics were included into our study. The patients were randomly classified into two groups.The patients of group I were implemented rectus sheath block accompanied by preoperative 0.25% levobupivakain and 0.2 ml/kg ultrasonography after general anesthesia. The patients of group II were implemented 0.1 mg/kg as morphine loading dose iv after the general anesthesia and the operation. For the postoperative pain, the patient-controlled analgesia (HKA) device was set with 0.01 mg/kg bolus and 30 minutes lock period for the both two groups.Sevoflurane concentration and the amounts those were inspired (%) and used (ml/hour) during the operation and some hemodynamic data such as intra-operative and post-operative systolic and diastolic blood pressures, heart rates and oxygen saturations of the both groups were measured and recorded. The consumption of analgesic with post-operative, pain scores (FLACC), the sedation level, nausea and vomiting, the number of cases which needed additional analgesic and the adverse effects were observed and noted.Findings: The demographic characteristics, the operation periods and hemodynamic parameters of the groups were similar. It was found that the sevoflurane concentrations inspired and consumed in the intra-operative period for the patients of group I were lower than the ones for the patients of group II. The average sevoflurane consumption was 18.7±2.1 ml/hour in the patients of group I and it was 21.5 ±2.9 ml/hour in the patients of group II (p<0.001).When the post-operative hemodynamic data was compared, it was found that systolic artery pressures were lower in the patients of group I than in the patients of group II and the other parameters were similar.The post-operative FLACC, the sedation scores and 24-hour cumulative morphine consumption were found lower in the patients of group I than in the patients of group II. (p<0.001)While nausea and vomiting were observed in 3 patients of group II but no nausea and vomiting was observed in any patients of group I. In addition, no need of additional analgesic was needed in any of the patients.Results: Consequently, it was seen that pre-operative sevoflurane consumption and the post-operative morphine consumption with HKA method were lower in the patients who was implemented pre-operative rectus sheath block than in the patients who was implemented post-operative iv. morphine. At the end of our study, we concluded that the implementation of rectus sheath block accompanied by USG provided an effective and reliable analgesia.Key words: Pediatric Patients, the Patient-controlled Analgesia, Levobupivakain, Rectus Sheath Block, Sevoflurane, Ultrasonography.