A Prospective Randomized Controlled Study of Ultrasound-Guided Rectus Sheath Block for Pain Management in Laparoscopic Umbilical Hernia Repair with Intraperitoneal Onlay Mesh.

Abstract

Objective: To evaluate the clinical efficacy and safety of ultrasound-guided rectus sheath block (RSB) in laparoscopic umbilical hernia repair with intraperitoneal onlay mesh (IPOM).

Methods: A total of 139 patients scheduled for laparoscopic umbilical hernia repair with IPOM were selected and randomly assigned to either the group receiving general anesthesia combined with bilateral rectus sheath block (Group GR, 71 patients) or the group receiving general anesthesia alone (Group G, 68 patients). We monitored the patients' heart rate (HR) and mean arterial pressure (MAP) at four time points: before anesthesia induction (T1), at the start of surgery (T2), during mesh fixation (T3), and upon removal of the laryngeal mask (T4). Postoperative pain levels were evaluated using the Visual Analogue Scale (VAS) at 1 hour (T5), 6 hours (T6), and 12 hours (T7) after surgery while resting, as well as at 24 hours (T8) during activity. We also compared the number of times the patient-controlled intravenous analgesia (PCIA) pump was pressed and the use of additional analgesics within 24 hours post-surgery, along with recording any adverse reactions and complications associated with RSB.

Results: At time points T2 and T3, the HR and MAP in Group GR were significantly lower than those in Group G (P < 0.05). Additionally, VAS scores at various postoperative intervals were lower in Group GR, with significant differences noted at T5, T7, and T8 (P < 0.05). Group GR also had significantly fewer presses on the analgesia pump within 24 hours post-surgery compared to Group G, while the incidence of adverse events was similar between the two groups.

Conclusion: Ultrasound-guided RSB is a straightforward and safe technique for laparoscopic umbilical hernia repair with IPOM. It offers clear analgesic benefits and significantly reduces early postoperative pain.