Background and Objectives: Multimodal analgesia has been shown to be effective in facilitating early postoperative gastrointestinal function and rehabilitation in patients undergoing open gastrectomy. We conducted a clinical trial to investigate the effectiveness of bilateral rectus sheath block (RSB) with continuous bupivacaine infusion in comparison with placebo following elective open gastrectomy. Materials and Methods: Patients indicated for elective open gastrectomy were screened, enrolled, and randomised between October 2021 and September 2023. The patients were randomised to either Group A (intervention—continuous bupivacaine) or Group B (control—NaCl saline). The primary outcome measures were the quantity of an opioid analgesic administered during the initial 72 h post-surgery and the level of postoperative pain as indicated by the visual analogue scale (VAS). Mann–Whitney U test was used for quantitative analysis while Pearson Chi-square was used for categorical variables. Results: A total of 60 patients completed the trial, with 30 patients in each of the two groups. Patients in Group A reported lower median VAS pain scores at all observed time points following surgery (p < 0.001). No patient in Group A required rescue opioid analgesia, although non-steroidal anti-inflammatory drugs were necessary during the initial 12 h postoperatively. Clinically, Group A patients had a significantly shorter time to first gas (p = 0.001), a shorter time to first bowel movement (p < 0.001), a shorter time to first out-of-bed activity (p < 0.001), and a shorter overall hospitalisation duration (p < 0.001) compared to Group B patients. Conclusions: Bilateral RSB with continuous bupivacaine infusion is effective in managing pain and can reduce the use of opioid analgesics in the postoperative period. Furthermore, it promotes early recovery, and a shorter hospital stay.

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 µg/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–Whitney U test, Friedman’s ANOVA with Bonferroni correction, and Chi-square or Fisher’s 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 < 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.

The aim of the study was to determine long-term outcome in Crohn’s disease patients hospitalised for acute abdominal pain. Retrospective chart review was made of consecutive Crohn’s disease patients hospitalised for acute abdominal pain at the tertiary referral centre in Eastern Europe. Between 2015 and 2020, 65 patients with Crohn’s disease were admitted at least once to the emergency room because of acute abdominal pain. Thirteen were admitted twice, eight — three times, three — four times, and three — five times. Most patients had ileal involvement. There were two intra-abdominal abscesses. Fifty-three of 65 underwent abdominal imaging. Forty-five were treated with antibiotics (65%), 17 with steroids (26%), eight received a nasogastric tube and three — parenteral nutrition. Six underwent an intestinal resection during the initial hospitalisation (9%). The hospitalisation length median was eight days and significantly longer in those who underwent surgery (28 vs. 9, p = 0.003). The median follow-up time was 42.8 months. During the follow-up period, 26 (40%) readmitted for abdominal emergencies, 14 underwent surgery — either at the initial or later hospitalisation (21%). Thirteen of 14 surgeries were emergencies, and three were concluded by ostomy formation (21%). One developed postoperative intra-abdominal complication, and two died postoperatively (14%). Complicated disease was associated with hospital readmission (HR, 5.8, 95% CI:1.4–23.3; p = 0.013) and enhanced probability to undergo intestinal surgery (HR, 10.3, 95% CI: 2.4–44.1; p = 0.002). An elevated CRP was associated with decreased risk of hospital readmission (HR, 0.08, 95% CI: 0.01–0.55; p = 0.010). Ileocolic disease was the main cause of hospitalisation for acute abdominal pain. Complicated (stricturing or penetrating) disease should be diagnosed early and surveilled closely.

Background. To determine long-term outcome in Crohn’s disease patients hospitalized for acute abdominal pain. Methods. Retrospective chart review of consecutive Crohn’s disease patients hospitalized for acute abdominal pain at the tertiary referral centre in Eastern Europe. Results. Between 2015 and 2020, 65 patients with Crohn’s disease were admitted at least once to hospitals’ emergency room because of acute abdominal pain. 13 patients were admitted twice, 8 three times, 3 patients four times and 3 patients five times. Also, the intake of immunosuppressive medication was apparently rare, thus, most patients have been treated by 5-ASA medication only. Most patients had ileal involvement. Two patients presented with an intraabdominal abscess. 53 of 65 patients underwent abdominal imaging during the hospitalization. After hospital admission, 45 patients were treated with antibiotics (65%),17 with steroids (17%), 8 patients received a nasogastric tube and 3 were put on parenteral nutrition. Six patients underwent an intestinal resection during the initial hospitalization (9%). The length of the hospitalization was median 8 days (range, 1 to 115) and it was significantly longer in those, who underwent surgery (mean 28 days vs. 9 days, p = 0.003). Follow-up information was obtained for all patients, and the median follow-up time was 42.8 months. During the follow-up period, 26 patients (40%) readmitted for abdominal emergencies. 14 patients underwent surgery – either at the initial or later hospitalization (21%). Thirteen out of 14 surgeries were emergencies, three were concluded by ostomy formation (21%). One patient developed postoperative intraabdominal complication, however, two patients died postoperatively (14%). By multivariate analysis, complicated disease (stricturing or penetrating) was associated with hospital readmission (Hazard ratio, 5.8, 95% CI: 1.4–23.3; p = 0.013). An elevated C-reactive protein level was associated with a decreased risk of hospital readmission (Hazard ratio,0.08, 95% CI: 0.01–0.55; p = 0.010). Also, complicated disease (stricturing or penetrating) was associated with enhanced probability to undergo intestinal surgery (Hazard ratio, 10.3, 95% CI: 2.4–44.1; p = 0.002) Conclusion. Ileocolic disease is the main cause of hospitalization for acute abdominal pain. Complicated (structuring or penetrating) disease should be diagnosed early and surveilled closely.