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REVIEW OF WOUND CATHETER USE IN A TERTIARY HEPATOBILIARY REFERRAL CENTRE
ESRA Academy. McMorrow F. Sep 8, 2016; 138444
Topic: REGIONAL ANAESTHESIA (RA) TECHNIQUES - CLINICAL IMPLICATIONS
Dr. Fintan McMorrow
Dr. Fintan McMorrow

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Abstract
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Background and Aims:

Wound catheters offer potential benefits in postoperative pain management and avoid the side-effect profile associated with traditional means, such as thoracic epidurals.

We present our experience with the use of wound catheters in major abdominal procedures, a new addition to the enhanced recovery protocol within our institution.

Methods:

Data was collected retrospectively on all patients undergoing major hepatobiliary surgery between February 2014 & October 2015 via a rooftop incision.  Each received intrathecal morphine at a dose up to 0.01mg/kg pre-operatively. Two multi-holed wound catheters were placed by the surgeon between anterior and posterior rectus sheath, and one elastomeric pump attached delivering a 10ml/hour infusion of 0.125% levo-bupivacaine over 72 hours. A morphine patient-controlled analgesia (PCA) pump was used post-operatively.

Results:

Seventy-one patients underwent surgery but complete data is available for 55 patients (77%). Average age was 60 (range 34-79 years) and 56% of patients were male. Average intrathecal morphine dose was 600micrograms (range 300-1000mcg). Average morphine consumption at 24 hours was 41mg (range 1mg-152mg). Five PCA’s were discontinued by 48 hours. Average total morphine consumption at 48 hours was 80mg (range 7mg-300mg). Twenty-five PCA’s were discontinued by 72 hours. Average total morphine consumption at 72 hours was 137mg (range 7mg-380mg). 95% of patients went to HDU post-operatively with an average stay of 6 days (range 3-27 days). Average total hospital stay was 15 days with 30-day mortality of 1.8%.

Conclusions:

Wound catheters appear to markedly reduce intravenous morphine consumption and are an essential constituent of multi-modal analgesia in our institution’s hepatobiliary enhanced recovery package.

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