This study aims to compare the effectiveness and safety of ultrasound-guided rectus sheath block versus intrathecal morphine for postoperative analgesia in patients undergoing open total abdominal hysterectomy.
Age: 18 - 65 years old.
American Society of Anesthesiologists (ASA) physical status (I -II).
Patients undergoing open total abdominal hysterectomy.
Hepatic, renal, or cardiac disease.
Any known allergy to local anesthetic.
Physical or mental conditions which may vague measuring postoperative pain following surgery.
History of chronic use of analgesic as nonsteroidal anti-inflammatory drugs (NSAIDs) or central nervous system (CNS) depressants as antiepileptic, and bleeding disorders.
Parallel
Rectus sheath block
DrugPatients will receive rectus sheath block (20 ml bilaterally, bupivacaine 0.25%) after induction of general anesthesia.
Intrathecal morphine
DrugPatients will receive 150 µg intrathecal morphine after induction of general anesthesia.
Total morphine consumption
Morphine will be administered if the visual analog scale (VAS) score is ≥ 4.
Time to the first request for the rescue analgesia
Time to the first request for the rescue analgesia (time from the end of surgery till first dose of morphine administrated)
Degree of pain
Each patient will be instructed about postoperative pain assessment with the Visual Analogue Scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be assessed after surgery over 24 hour using VAS scale at (post-anesthesia care unit, 2, 4, 6, 12, 18, and 24 h).
Degree of sedation
Sedation will be assessed using Modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S): (5 Alert: Responds readily to name spoken in normal tone, 4: Lethargic response to name spoken in normal tone, 3: Responds only after name is called loudly and/or repeatedly, 2: Responds only after mild prodding or shaking ,1: Responds only after painful trapezius squeeze,0: Does not respond to painful trapezius squeeze).
Degree of patient satisfaction
The degree of patient satisfaction will be assessed on a 5-point Likert scale patient satisfaction (1, extremely dissatisfied; 2, unsatisfied; 3, neutral; 4, satisfied; 5, extremely satisfied).
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