Epidural vs. incisional infusion for analgesia in abdominal laparotomy

Epidural analgesia is traditionally used for postoperative pain control after abdominal laparotomy, but continuous incisional infusion is being considered as a comparable alternative with potentially fewer side effects. This study aimed to determine if incisional catheters provide equivalent analgesia to epidurals and if they are associated with fewer adverse effects.

A prospective observational study included 498 patients from January 1, 2022, to January 31, 2024, with 390 using epidural catheters (Epi) and 108 using incisional catheters (Inc). Analgesic effectiveness was measured using EVA scores, QoR15, SCQIPP, and incidence of adverse effects. Data analysis included Student’s t-test for continuous variables and chi-square for discrete variables, with normal distribution confirmed by the Shapiro-Wilks test.

Results showed that epidural catheters provided superior analgesia in the first two hours postoperatively (EVA 1-2 hours: 4.22±2.49 in Inc, 1.54±1.13 in Epi, p<0.05), but pain perception equalized at 24 and 48 hours (EVA 24h: 2.79±1.84 in Inc, 2.59±1.86 in Epi; EVA 48h: 1.7±1.34 in Inc, 1.57±1.26 in Epi, p>0.05). There were no significant differences in QoR15 scores at 24 and 48 hours or SCQIPP scores at discharge. Incisional catheters were associated with significantly fewer adverse effects such as nausea, motor block, and paresthesias, but there were no differences in the incidence of hypotension or urinary retention.

In conclusion, while epidural analgesia provides better immediate pain relief, incisional catheters offer similar analgesic quality after the first two hours and result in fewer adverse effects, making them a viable alternative for postoperative pain management.