Background and Aims Pain following emergency laparotomy can be difficult to manage and there is little evidence to guide best practice. We assessed current practice by reviewing analgesic modalities used within our department, including rectus sheath catheters (RSC).
Methods This audit was authorized by local committee as not requiring ethical approval. Data collection was retrospective including all patients undergoing emergency laparotomy, meeting local inclusion criteria for RSC at the Royal Liverpool University Hospital (table 1), September 2019 – March 2020.
Results 61 patients were included. 31 (50.8%) patients had RSC with 0.2% ropivicaine infusions running at an average 7.97 mls/h (S.D. 1.45) for a median 3 days. Median age was higher in RSC vs no RSC (72.5 vs 63 years). Patients with no RSC received alternative analgesic techniques including; spinal anaesthesia (1), transverse abdominis plane blocks (13) and IV lidocaine infusion (4). Despite this we noted a lower opioid requirement 72h post-operatively in RSC patients vs no RSC (mean 93.5 mg (S.D. 76.3) vs 125.4 mg (S.D. 105.7)), with lower average pain scores noted at 1, 24 and 72 hours in the RSC group (table 2). Ketamine use was more frequent in the no RCS group (20% vs 6.5%). 59 (96.7%) received an opioid PCA post-operatively.
Conclusions Lower opioid requirements associated with RSC is consistent with other studies including a 2019 Cochrane review. The infrequent use of spinal techniques (1.6%) may reflect concerns regarding safety in the emergency setting. Our results support available evidence, and suggest RSCs should be considered in emergency laparotomy