Original article / research
Continuous Rectus Sheath Block versus Epidural Analgesia for Postoperative Haemodynamic Stability after Elective Midline Laparotomy: A Randomised Controlled Trial
UC11-UC14
Correspondence
Dr. Gayathri Balasubramaniyan,
Professor and Head, Department of Anaesthesiology, SRMMCH&RC, Kattankukathur, Chennai 603203, Tamil Nadu, India.
E-mail: lakshmesanjanakarthik.1999@gmail.com
Introduction: Effective postoperative pain management is essential for optimal recovery after elective midline laparotomy. While epidural analgesia is widely used, it may cause sympathetic blockade, leading to hypotension and bradycardia. Continuous Rectus Sheath Block (CRSB) is a potential alternative that provides effective analgesia without compromising haemodynamic stability.
Aim: To compare postoperative haemodynamic stability between CRSB and epidural analgesia in patients undergoing elective midline laparotomy.
Materials and Methods: This single-blinded randomised controlled trial was conducted at the Department of Anaesthesiology, SRM Medical College, Hospital and Research Centre, Tamil Nadu, India, from August 2024 to February 2026. A total of 64 adult patients, American Society of Anaesthesiology Physical Status (ASA I-III), scheduled for elective midline laparotomy, were enrolled and randomly assigned to two groups: Group CRSB (n=32) receiving continuous bilateral RSB and Group Epidural (n=32) receiving standard epidural analgesia. Demographic data, including age, gender, and Body Mass Index (BMI), were recorded at baseline. Postoperative haemodynamic parameters, Mean Arterial Pressure (MAP) and heart rate, were measured at predetermined intervals. Pain was assessed using the Visual Analogue Scale (VAS), and the time to return of bowel sounds was recorded. Statistical analysis was performed using Student’s t-test and Chi-square test, with p<0.05 considered statistically significant.
Results: Both groups were comparable in baseline demographics (mean age 48.5±10.2 years). The CRSB group experienced faster return of bowel function (p=0.027).
Conclusion: The CRSB provides analgesia equivalent to epidural analgesia, with improved haemodynamic stability and accelerated gastrointestinal recovery. It represents a safe and effective alternative, particularly for patients at risk of haemodynamic compromise.