{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T22:27:46Z","timestamp":1791239266939,"version":"4.1.0"},"reference-count":17,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Thoracic epidural analgesia (TEA) is considered the gold standard for postoperative pain control following major abdominal surgery. Bilateral rectus sheath block (RSB) is a promising alternative regional technique. This study aimed to compare the efficacy of RSB and TEA in managing early postoperative pain and enhancing recovery after open gastrectomy. Materials and Methods: Between October 2021 and December 2024, 70 patients scheduled for elective open gastrectomy were randomized into two groups: Group A (RSB with continuous bupivacaine infusion) and Group B (TEA with 10 mg bupivacaine plus 1 \u00b5g\/mL fentanyl). Primary outcomes included opioid consumption within 72 h postoperatively and pain intensity measured using the visual analog scale (VAS). Statistical analysis was conducted using the Mann\u2013Whitney U test, Friedman\u2019s ANOVA with Bonferroni correction, and Chi-square or Fisher\u2019s exact test for categorical variables. Results: A total of 64 patients were finally included (30 in RSB, 34 in TEA). VAS scores in the RSB group were significantly lower at 24 and 48 h postoperatively compared to baseline (p &lt; 0.001). Between-group comparisons showed consistently lower pain scores in the RSB group at all measured time points. At 48 h, 94% of patients in the TEA group required rescue analgesia, compared to only 17% in the RSB group. Additionally, the RSB group had a significantly shorter postoperative hospital stay (mean 6 vs. 9 days) and demonstrated earlier return of bowel function. Conclusions: RSB is a safe and effective alternative to TEA for analgesia after open gastrectomy. It significantly lowers pain scores, reduces opioid and rescue medication use, shortens hospital stay, and enhances early recovery. Bilateral rectus sheath block with continuous bupivacaine infusion significantly lowers pain scores, reduces opioid and rescue medication use, shortens hospital stay, and facilitates early recovery.<\/jats:p>","DOI":"10.3390\/medicina61091695","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T12:24:25Z","timestamp":1758198265000},"page":"1695","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparison of Bilateral Rectus Sheath Block and Thoracic Epidural Analgesia for Postoperative Pain Control After Open Gastrectomy: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3639-4983","authenticated-orcid":false,"given":"Janis","family":"Opincans","sequence":"first","affiliation":[{"name":"Department of Surgery, Riga East Clinical University Hospital, 1038 Riga, Latvia"},{"name":"Faculty of Medicine, University of Latvia, 1004 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6467-136X","authenticated-orcid":false,"given":"Igors","family":"Ivanovs","sequence":"additional","affiliation":[{"name":"Department of Surgery, Riga East Clinical University Hospital, 1038 Riga, Latvia"},{"name":"Faculty of Medicine, University of Latvia, 1004 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksejs","family":"Miscuks","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Latvia, 1004 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janis","family":"Pavulans","sequence":"additional","affiliation":[{"name":"Department of Surgery, Riga East Clinical University Hospital, 1038 Riga, Latvia"},{"name":"Faculty of Medicine, Riga Stradins University, 1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elina","family":"Zemite","sequence":"additional","affiliation":[{"name":"Department of Surgery, Riga East Clinical University Hospital, 1038 Riga, Latvia"},{"name":"Faculty of Medicine, University of Latvia, 1004 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agris","family":"Rudzats","sequence":"additional","affiliation":[{"name":"Department of Surgery, Riga East Clinical University Hospital, 1038 Riga, Latvia"},{"name":"Faculty of Medicine, University of Latvia, 1004 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zurabs","family":"Kecbaja","sequence":"additional","affiliation":[{"name":"Department of Surgery, Riga East Clinical University Hospital, 1038 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0645-3863","authenticated-orcid":false,"given":"Aleksejs","family":"Kaminskis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Riga East Clinical University Hospital, 1038 Riga, Latvia"},{"name":"Faculty of Medicine, University of Latvia, 1004 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Opincans, J., Ivanovs, I., Miscuks, A., Pavulans, J., Martinsone, K.D., Rudzats, A., Kecbaja, Z., Gutnikovs, O., and Kaminskis, A. (2024). Bilateral Rectus Sheath Block with Continuous Bupivacaine Infusions After Elective Open Gastrectomy: A Randomized Controlled Trial. Medicina, 60.","DOI":"10.3390\/medicina60121992"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3197","DOI":"10.21608\/ejhm.2022.246930","article-title":"Thoracic Epidural versus Surgically placed Rectus Sheath Catheters for Postoperative Analgesia after Midline Laparotomies: A Randomized clinical Trial","volume":"88","author":"Waly","year":"2022","journal-title":"Egypt. J. Hosp. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Mazzotta, E., Villalobos-Hernandez, E.C., Fiorda-Diaz, J., Harzman, A., and Christofi, F.L. (2020). Postoperative Ileus and Postoperative Gastrointestinal Tract Dysfunction: Pathogenic Mechanisms and Novel Treatment Strategies Beyond Colorectal Enhanced Recovery After Surgery Protocols. Front. Pharmacol., 11.","DOI":"10.3389\/fphar.2020.583422"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.amjsurg.2023.07.020","article-title":"Incidence and risk factors for postoperative gastrointestinal dysfunction occurrence after gastrointestinal procedures in US patients","volume":"226","author":"Zhong","year":"2023","journal-title":"Am. J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"345","DOI":"10.4097\/kja.d.18.00217","article-title":"Designing the ideal perioperative pain management plan starts with multimodal analgesia","volume":"71","author":"Schwenk","year":"2018","journal-title":"Korean J. Anesthesiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"394","DOI":"10.4097\/kja.20304","article-title":"Continuous peripheral nerve blocks compared to thoracic epidurals or multimodal analgesia for midline laparotomy: A systematic review and meta-analysis","volume":"74","author":"Bailey","year":"2021","journal-title":"Korean J. Anesthesiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1186\/1745-6215-15-400","article-title":"Thoracic Epidural analgesia versus Rectus Sheath Catheters for open midline incisions in major abdominal surgery within an enhanced recovery programme (TERSC): Study protocol for a randomised controlled trial","volume":"15","author":"Wilkinson","year":"2014","journal-title":"Trials"},{"key":"ref_8","unstructured":"Webster, K. (2025, July 09). Ultrasound Guided Rectus Sheath Block\u2014Analgesia for Abdominal Surgery. Available online: https:\/\/e-safe-anaesthesia.org\/e_library\/09\/Ultrasound_guided_rectus-sheath_block_Update_2010.pdf."},{"key":"ref_9","first-page":"524","article-title":"Maximum recommended doses of local anesthetics: A multifactorial concept","volume":"29","author":"Rosenberg","year":"2004","journal-title":"Reg. Anesthesia Pain Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e41189","DOI":"10.2196\/41189","article-title":"Development of the Emoji Faces Pain Scale and Its Validation on Mobile Devices in Adult Surgery Patients: Longitudinal Observational Study","volume":"25","author":"Li","year":"2023","journal-title":"J. Med. Internet Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e15159","DOI":"10.1097\/MD.0000000000015159","article-title":"Analgesic effectiveness of rectus sheath block during open gastrectomy: A prospective double-blinded randomized controlled clinical trial","volume":"98","author":"Hong","year":"2019","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2619","DOI":"10.1007\/s00423-022-02602-9","article-title":"Principles of enhanced recovery in gastrointestinal surgery","volume":"407","author":"Roulin","year":"2022","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"750","DOI":"10.4103\/ija.IJA_976_19","article-title":"Comparison of postoperative analgesia and opioid requirement with thoracic epidural vs. continuous rectus sheath infusion in midline incision laparotomies under general anaesthesia\u2014A prospective randomised controlled study","volume":"64","author":"Gupta","year":"2020","journal-title":"Indian J. Anaesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e18263","DOI":"10.5812\/aapm.18263","article-title":"Reducing postoperative opioid consumption by adding an ultrasound-guided rectus sheath block to multimodal analgesia for abdominal cancer surgery with midline incision","volume":"4","author":"Bashandy","year":"2014","journal-title":"Anesthesiol. Pain Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.bjmsu.2010.05.003","article-title":"The use of rectus sheath catheters as an analgesic technique for patients undergoing radical cystectomy","volume":"4","author":"Parsons","year":"2011","journal-title":"Br. J. Med. Surg. Urol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e14244","DOI":"10.5812\/aapm.14244","article-title":"The Analgesic Efficiency of Ultrasound-Guided Rectus Sheath Analgesia Compared with Low Thoracic Epidural Analgesia After Elective Abdominal Surgery with a Midline Incision: A Prospective Randomized Controlled Trial","volume":"7","author":"Yassin","year":"2017","journal-title":"Anesthesiol. Pain Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"947","DOI":"10.4103\/ija.IJA_236_19","article-title":"Knotty Catheter!\u2014An unusual complication of rectus sheath block","volume":"63","author":"Doctor","year":"2019","journal-title":"Indian J. Anaesth."}],"updated-by":[{"DOI":"10.3390\/medicina62091729","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000}}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/9\/1695\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:20:30Z","timestamp":1788862830000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/9\/1695"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":17,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["medicina61091695"],"URL":"https:\/\/doi.org\/10.3390\/medicina61091695","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,18]]}}}