Background and Aims This systematic review has been performed to assess the efficacy of post-operative analgesia using bolus infusions of local anaesthetic given via rectus sheath catheters in patients undergoing laparotomy via midline incisions.
Methods A PubMed search of the literature has been used to capture all the relevant publications. All studies where rectus sheath analgesia has been compared with placebo and with epidural anaesthesia have been analysed. The review has revealed that there is considerable variation in the methodologies used in the published studies comparing rectus sheath and epidural analgesia and the majority are non-randomised observational studies. Some of the studies suggest that rectus sheath analgesia is less effective than epidural analgesia when assessed with post-operative pain scores and the need for additional opiate analgesia. Others suggest that rectus sheath analgesia gives equivalent pain relief to epidural anaesthesia. Some of the studies show that patients receiving rectus sheath analgesia mobilise quicker than those receiving epidural anaesthesia.
Results All the studies emphasise that rectus sheath analgesia is safer than epidural anaesthesia as it avoids the major complications that can occur with epidural anaesthesia, which include post-operative hypotension leading to anastomotic leakage, epidural haematoma, and epidural abscess formation. The literature shows that complications from rectus sheath analgesia are extremely rare.
Conclusions This systematic review has shown that although further prospective randomised studies are required, rectus sheath analgesia is safe and effective and should be used in preference to epidural anaesthesia in most patients undergoing laparotomy via midline incision.
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