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RECTUS SHEATH CATHETER INFUSION FOR POST-OPERATIVE PAIN MANAGEMENT IN LAPAROTOMY
ESRA Academy. Tameem A. Sep 8, 2016; 138347; 0183 Topic: ADJUVANT DRUGS
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Dr. Alifia Tameem
Dr. Alifia Tameem

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Abstract
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Background and Aims:

The comparative efficacy of rectus sheath catheter (RSC) use for abdominal surgeries is yet to be proven. This study evaluates our current practice using RSC following midline laparotomy

Methods:

Using a standard proforma, demographics, pain scores and opioid use up to 3 post-operative days were retrospectively recorded. The pain score was a numerical rating scale of 0-3 (0 no pain, 1 mild pain, 2 moderate pain, 3 severe pain). All RSC infusions followed the trust protocol of 10ml/hour 0.2% ropivacaine, 10ml bolus and 2 hour lockout.

Results:

20 patients who had undergone a laparotomy with RSC placed intra-operatively were identified. 19 patients had general anaesthetic only, 1 had a combined general and spinal anaesthetic. The median age was 69 (25-86), 11 males, 9 females. 13 patients were elective and 7 emergency laparotomy. There were no reported adverse effects from the RSC. 9 patients had morphine PCA in addition to RSC.  

Post-operative pain scores were low (figure 1). The number of patients requiring post-operative opioid in addition to RSC is shown in figure 2. The total dose of morphine required is shown in table 3.

Conclusions:

Low pain scores were reported suggesting RSC provides effective post-operative analgesia. Most had low opioid requirements with only 2 patients requiring higher doses via PCA. We are not advocating superiority to epidural analgesia, but a safe and effective alternative where neuroaxial blockade is contraindicated. We also propose an opioid sparing effect and role in multimodal analgesia for those with established chronic pain.

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