Background and aims The infusion of local anaesthetic via wound catheters is an alternative to thoracic epidurals for effective analgesia after abdominal operations, particularly if epidurals are contraindicated, not wanted by the patient or technically impossible. Therefore, abdominal wound catheters were introduced in our trust to reduce opioid consumption and related side effects and to provide effective analgesia.
Methods This is a prospective audit of randomly selected adult patients who underwent laparotomies between March and December 2018 with (19 patients) and without (9 patients) wound catheters.
The primary outcome was pain scores at rest and on movement for 5 days post-operatively. The secondary outcome was opioid consumption for 5 days post-operatively. All patients were provided with opioids via PCA (patient-controlled analgesia).
Further peri-operative data were collected, such as anaesthetic technique, local anaesthetic boluses, anti-emetics in recovery and documentation.
Results In the wound catheter cohort, lower median pain scores were found post-operatively, particularly on movement and within the first 72 hours. Patients with wound catheters required less Morphine via PCA (66 vs. 79 mg). Pre-operative spinal injections for visceral pain relief were only used in 25% of cases. Boluses of 0.25% Levo-Bupivacaine were administered via the wound catheters, but not documented in 32%.
Conclusions Patients with abdominal wound catheters after laparotomies had a reduction in post-operative pain scores and reduced opioid consumption. Further training of surgeons inserting wound catheters and staff looking after these patients is required. Improved documentation and monitoring of patient satisfaction.
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