Ultrasound-guided rectus sheath catheters: A feasible and effective, opioid-sparing, post-operative pain management technique: A case series

Abstract

Epidural analgesia, though the gold standard of post-operative pain management for laparotomies, is associated with limitations and is contraindicated in many patients. Opioid-based pain management, which is an alternative to epidural, has been implicated in post-operative nausea, vomiting, and ileus. We report successful management of post operative pain with ultrasound guided rectus sheath (RS) catheters. RS block is a promising alternative in scenarios were epidural is contraindicated, has failed or in case of unexpected change in the surgical plan.

Postoperative analgesia of ultrasound guided rectus sheath catheters versus continuous wound catheters for colorectal surgery: A randomized clinical trial

“…Similar results were obtained by Shido et al [17], Parson et al [18], Malchow et al [19], Godden et al [20], Dutton et al [21] and Bakshi et al [22]. In contrary to our results, Pandmanbhan et al [23] found that intermittent infusion of bupivacaine after midline laparotomy into the rectus sheathspace does not reduce pain score postoperatively.…”

Essentials of Our Current Understanding

“…[193][194][195] One small RCT has been published to date that showed no difference in opioid consumption or pain scores over a 48-hour period between patients receiving intermittent boluses of either bupivacaine or saline through bilateral, surgically inserted rectus sheath catheters following midline laparotomy. 188 In contrast, 2 recent retrospective reviews of patients undergoing open colorectal surgery indicate that rectus sheath catheters may be as effective as epidural analgesia while offering a superior side-effect profile.…”

Comparative Study of Ultrasound Guided Modified Rectus Sheath Block With Conventional Post-Operative Analgesia in Lower Abdominal Surgeries

“…This may be due to use of pre-emptive analgesia i.e before incision. Sumitra Bakshi [7] et al used USGRSB as an alternative method to provide post operative analgesia in their case series and concluded that USGRSB with catheterisation can be feasible and effective pain management technique for midline laparotomy and can be considered when epidural analgesia is not a suitable option.…”