Rhomboid Intercostal and Subserratus Plane Block Versus Quadratus Lumborum Block in Management of Postoperative Pain After Open Nephrectomy

Open nephrectomy is an important surgery in treatment of patients with renal cancer, ultrasound guidance is rapidly becoming the gold standard for regional anesthesia. There is an evidence matched with improving technology to show that the use of ultrasound has significant benefits over conventional techniques, such as nerve stimulation and loss of resistance. The improved safety and efficacy that ultrasound brings to regional anesthesia helped promote its use and realize the benefits that regional anesthesia has over general anesthesia, such as decreased morbidity and mortality, superior post-operative analgesia, cost-effectiveness, decreased postoperative complications and an improved postoperative course .

The Rhomboid intercostal and subserratus plane block (RISS) is a relatively newer block technique described by Elsharkawy et al.

The RISS provides analgesia for the regions supplied by T3 - T6 thoracic nerves, analgesia of the RISS block may be due to two different mechanisms. First, the block mainly affects the thoracic intercostal dorsal rami emerging under the erector spinae muscle at the level of T3-T9, where it is attached to the transverse spinal processes. Second, the injected local anesthetic may extend to the paravertebral space under the erector spinae muscle Quadratus lumborum block (QLB) is a new abdominal truncal block for controlling somatic pain in both the upper and lower abdomen.

Although the concept of the block is similar to that of lateral transverses-abdominis plane block (TAPB), the extent of the effect has been suggested to be greater because the point of injection is more dorsal. Local anesthetics are administered into the space between the quadratus lumborum muscle and the medial layer of the thoracolumbar fascia to achieve QLB, which can spread to the paravertebral space .

Inclusion criteria

• Patients undergoing open nephrectomy.
• ASA physical status II, III
• Sex (males and females)
• Age 40-70 years

Exclusion criteria

Patient refusal or with difficulties in comprehending visual analogue scale (VAS) pain scores

• Any contraindications for regional anesthesia. (eg: coagulopathy, use of anticoagulants or antiplatelets...)
• Hypersensitivity to local anesthetics.
• Infection near site of injection.