Application of Rectus Sheath Block based-on Incision in Upper Abdominal Surgery

Application of Opioid-sparing Multimodal Anesthesia Based on Rectus Sheath Block in Open Upper Abdominal Surgery:A Randomized Controlled Study

General anesthesia combined subcostal transversus abdominis plane (TAP)or rectus sheath block (RSB)can significantly reduce the use of opiates in minimally invasive surgery.However, similar reduction was not observed in open abdominal surgery during perioperative period.Therefore, the investigators should try to improve the blocking methods to reduce the side effects of a large number of opiates. Based on the range and its analgesic effect of various nerve block is obviously related to the injection site of local anesthetics, this randomized controlled study hypothesized that modified RSB under the guidance of surgical incision may be more effective in inhibiting the harmful stimulation of surgery.

For abdominal cancer surgery with midline incision, subcostal transversus abdominis plane or rectus sheath block combined with general anesthesia was more effective in reducing pain scores and opioid consumption compared with general anesthesia alone. However, there was no statistically significant difference in supplementary fentanyl during operation. Besides adequate pain relief around incisions, blunting visceral traction response has also an important role in hemodynamic stability.With the evidences for a potential mechanism for the antinociceptive effects of propofol on visceral nociception and dexmedetomidine combined with oxycodone can provide good visceral analgesia, the investigators supposed that visceral nociception was well suppressed by adequate antinociceptive drugs. The propofol combination with dexmedetomidine may had significant effect on the reduction of the sympathoadrenergic tone with decrease of blood pressure and heart rate.

Inclusion Criteria:

• Aged 18-85 years
• Anesthesiologists (ASA) risk classification I to IV
• Scheduled to undergo midline incision of upper abdomen (From xiphoid to navel )

Exclusion Criteria:

• Patient refusal
• Any contraindications to regional techniques (allergy to local anesthetics, infection around the site of the block, and coagulation disorder)
• History of analgesics dependence
• Any difficulty with communication
• Allergy to the study drugs
• Heat rate < 50 beats/minutes or II-III Atrioventricular block
• Previous open surgery
• Previous definite history of malignant tumor
• Who had an estimated intraoperative blood loss of more than 500 mL