Effect of the rectus sheath block on postoperative quality of recovery in open gynecological surgery as a part of multimodal anesthesia: A retrospective case review

Introduction: Open gynecological surgery results in a large wound and severe postoperative pain, and adequate
postoperative analgesia is necessary. Rectus sheath block (RSB) is used to block the sensory nerves of the anterior
abdominal wall thereby contributing to pain relief after lower abdominal surgeries. RSB provides effective
perioperative analgesia and is related to lower perioperative opioid consumption and decreased opioid-related
adverse effects. The retrospective case review explores the effect of RSB on the quality of recovery in patients
following open gynecological surgery.
Objective: The aim of this study is to evaluate the effect of bilateral Ultrasound (US)-guided RSB on the quality of
recovery after open gynecological surgery.
Patients and Methods: This retrospective case note review was carried out on 19 females, ASA I or II, who presented
for elective TAH under general anesthesia (GA) and received RSB with 40 ml ropivacaine 0.375% (20ml each side)
before surgery and standard endotracheal anesthesia. The primary outcome was the quality of recovery on the
first postoperative day. The quality of recovery was assessed by the 40-item Quality of Recovery questionnaire
(QoR-40). Secondary outcomes included the intraoperative opioid consumption, time to first flatus and time to first
discharge from bed, postoperative nausea and vomiting, and patient satisfaction.
Conclusion: Postoperative global QoR-40 scores were in the group of patients in the range 359.07-338.05 (314.5-349),
respectively. Preoperative RSB reduced intraoperative opioid consumption, reduced the time to first flatus, time
to first discharge from bed, and the post-anesthesia care unit discharge time. Furthermore, patients showed great
satisfaction.