Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain Management1993-65082687-1394Eco-Vector4288010.17816/RA42880Research ArticleASSESSMENT OF RECTUS SHEATH BLOCK EFFECTIVENESS AFTER MAJOR ABDOMINAL SURGERYSholinI. Y-AvetisyanV. A-EzugbaiaB. S-ZhikharevV. A-KoryachkinV. A-Scientific Research Institute - S.V. Ochapovsky Regional Clinic Hospital № 1Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden15032018121374024082020Copyright © 2018, Eco-Vector2018Objective. Assessment of rectus sheatus block effectiveness after major abdominal surgery. Material and methods. 120 patients after gastrectomy and pancreatoduodenal resections were examined. In the postoperative period, patients of the 1st group (n = 40) were given epidural infusion of 0.2% solution of ropivacaine 5 ml / h, patients of the 2nd (n = 40) and 3rd groups (n = 40) in the rectus sheatus introduced 10 ml of a 0.375% solution of ropivacaine with an interval of 8 hours and a constant infusion of 0.2% solution of ropivacaine 5 ml/h were bolus administered respectively. The intensity of the pain syndrome was assessed at rest and during mobilization, and frequency the need for additional of narcotics, suppuration, and patient satisfaction. Results. The intensity of the pain syndrome for 48 hours had no significant difference. The need for drugs in the 2nd group was less than in the 1st and 3rd groups. The incidence of wound suppuration between the groups did not differ significantly. The patient’s satisfaction with analgesia was 3.8 ± 0.44 points in the 2nd group, 2.7 ± 0.88 points and 2.6 ± 0.73 points in the 1st and 2nd groups (p <0, 05). Conclusion. The bolus injection of a local anesthetic solution into the of rectus sheatus after extensive abdominal operations provides postoperative analgesia comparable to epidural analgesia, does not require special skills from an anesthesiologist, is safe and effective.postoperative painbilateral rectus sheath block epidural analgesiaropivacaineпослеоперационная больблокада влагалища прямой мышцы животаэпидуральная аналгезияропивакаин[Страшнов В.И., Забродин О.Н., Мамедов А.Д., Страшнов А.В., Корячкин В.А. Предупреждение интраоперационного стресса и его последствий. СПб.: ЭЛБИ-СПб; 2015. 160 с.][Jakobsson J., Johnson M.Z., Perioperative regional anaesthesia and postoperative longer-term outcomes. F1000Research. 2016, 5 (F1000 Faculty Rev): 2501.][Gan T.J. Poorly controlled postoperative pain: prevalence, consequences, and prevention. Journal of Pain Research. 2017; 10:.2287-98.][Dajczman E., Gordon A., Kreisman H., Wolkove N. Long-term postthoracotomy pain. Chest. 1991; 99: 270-4.][Young A, Buvanendran A. Recent advances in multimodal analgesia. Anesthesiol. Clin. 2012; 30: 91-100.][Rawal N Epidural technique for postoperative pain: gold standard no more? Reg. Anesth. Pain Med. 2012; 37(3): 310-7.][Rawal N. Current issues in postoperative pain management. Eur. J. Anaesthesiol. 2016; 33: 160-71.][Mukhtar K Transversus abdominis plane (TAP) block. Journal of New York school of regional anesthesia. May 2009; 12(5): 28-33.][Gritsenko K., Khelemsky Y., Kaye A.D., Vadivelu N., Urman R.D. Multimodal therapy in perioperative analgesia. Best Pract. Res. Clin. Anaesthesiol. 2014; 28: 59-79.][Ljungqvist O., Scott M., Fearon K.C. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017; 152(3): 292-8.][Liu V.X., Rosas E., Hwang J., Cain E., et al. Enhanced Recovery After Surgery Program Implementation in 2 Surgical Populations in an Integrated Health Care Delivery System. JAMA Surg. 2017; 152(7): e171032.][Ежевская А.А., Прусакова Ж.Б., Максимова Л.П., Шолкина М.Н., Балмусова Е.А., Овечкин А.М., Влияние эпидуральнои анестезии на стрессиндуцированную иммуносупрессию при больших корригирующих операциях на позвоночнике. Анестезиология и реаниматология. 2014; 6: 4-9.][Корячкин В.А., Страшнов В.И. Спинномозговая и эпидуральная анестезия. Санкт-Петербург; 1998.][Горобец Е.С. Принципы анестезии при абдоминальных онкологических операциях. Регионарная анестезия и лечение острой боли. 2009; 3(2): 32-42.][Zheng X., Feng X., Cai X.-J. Effectiveness and safety of continuous wound infiltration for postoperative pain management after open gastrectomy, World J. Gastroenterol. 2016; 22(5): 1902-10.][Bertoglio S., Fabiani F., Negri P.D., et al. The postoperative analgesic efficacy of preperitoneal continuous wound infusion compared to epidural continuous infusion with local anesthetics after colorectal cancer surgery: a randomized controlled multicenter study. Anesth. Analg. 2012; 115(6): 1442-50.][Johnson S.M., Saint John B.E., Dine A.P. Local anesthetics as antimicrobial agents: a review. Surg. Infect. (Larchmt). 2008; 9(2): 205-13.]