Effect of Adding Dexmedetomidine to Bupivacaine in Ultrasound Guided Rectus Sheath Block: A Randomized Controlled Double-blinded Study

Wafaa T Salem1, Khaled A Alsamahy1, Wael A Ibrahim1, Abear S Alsaed2, Mohamed M Salaheldin1, *
1 Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
2 Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt

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© 2019 Salem et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Egypt Fom EL Khaleeg, Cairo, Egypt; Tel: +20237604220; Email:



Extended midline laparotomy incision is accompanied by intense pain postoperatively which affects patients’ physiology; therefore, good control of postoperative pain is mandatory to decrease the adverse effects on the body. Ultrasound-guided Bilateral Rectus Sheath Block (BRSB) is one of the options to achieve this goal.


The study aimed to assess the analgesic potency of adding dexmedetomidine to bupivacaine in ultrasound-guided BRSB in cancer patients with a midline laparotomy incision.


Sixty adult cancer patients planned for laparotomies with extended midline incision were included. Ultrasound-guided BRSB was performed immediately after the induction of anesthesia.

Patients were classified randomly into two groups; B group, where only bupivacaine was used for BRSB and BD group in whom a mixture of bupivacaine and dexmedetomidine was used.


A significant decrease in visual analogue scale scores, total morphine consumption, postoperative nausea and vomiting and postoperative cortisol levels was observed in group BD.


Dexmedetomidine as an adjuvant to bupivacaine in US-guided rectus sheath block bilaterally proved to be effective for proper pain management postoperatively in cancer patients after extended midline abdominal incision.

Keywords: Rectus sheath block, Dexmedetomidine, Pain, Regional anesthesia, Midline abdominal incision, Abdominal cancers.