The analgesic effects of ultrasound-guided recto-intercostal fascial plane block in laparoscopic hiatus hernia repair: A randomized double-blind controlled study.

BACKGROUND

Pain after laparoscopic hiatus hernia repair (LHHR) is multifactorial, with parietal pain representing up to 70% of its origin. Opioid induced postoperative nausea and vomiting (PONV) is of great concern, as it may predispose to anatomical failure and the need for revision. This study evaluated the opioid sparing value of the recto-intercostal fascial plane block (RIFPB) in this manner.

METHODS

A randomized, double-blind, controlled trial was conducted on 44 patients who were assigned equally into a RIFPB group [20 mL of bupivacaine (0.25%) for each side] and a control group [(C), without block]. The primary aim was the total 24 h opioid consumption post-surgery, and secondary outcomes included intraoperative fentanyl consumption, postoperative pain scores, PONV incidence, and patient satisfaction scores.

RESULTS

The RIFPB group had significantly lower 24-h postoperative morphine consumption than the control group (9 ± 3 mg vs. 20.8 ± 6.9 mg); P <  0.001. The median (IQR) fentanyl dose was significantly lower in the RIFPB group than in group C, 0.5 (0-1) vs. 2 (1-2) µg/kg; P <  0.001. The RIFPB group had a significantly prolonged time to first morphine request (P <  0.001), lower postoperative pain scores at all assessment time points (P <  0.05) except at 8 h after surgery, a higher median value of patient satisfaction scores (4 vs. 3; P <  0.001), and a lower incidence of PONV, P =  0.034.

CONCLUSION

The RIFPB reduced the intraoperative nociception and the 24-h postoperative opioid consumption after LHHR. Also, it delayed the need for rescue morphine; reduced pain scores, PONV incidence, and increased patient satisfaction after surgery.

REGISTRATION: ClinicalTrials.gov (NCT06820216).