Background and Aims Epidural analgesia, though the gold standard of post-operative pain management for laparotomies, is associated with limitations and is contraindicated in many patients. Continuous rectus sheath (RS) block can provide alternative analgesia after midline laparotomy.

Methods We report 5 cases in which continuous local anesthetic infusion through ultrasound-guided (USG) RS catheters showed effective postoperative pain management for midline laparotomy.The multimodal approach for postoperative analgesia for all 5 patients was: paracetamol 1g 8/8h, ketorolac 30 mg 12/12h or metamizole 2g 8/8h and ropivacaine 0,2% through DIB system (5,2 ml/h) through a bilateral percutaneous USG RS catheter during 72h. Tramadol 100 mg as rescue analgesia.

Results Patient´s pain intensity assessed by numerical rating scale during first 72h and the number of times necessary to administer rescue analgesia was also recorded (see table 1).

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Abstract 225 Figure 1

Conclusions With this case series, the authors showed that bilateral percutaneous USG RS catheter as part of a multimodal analgesia regime seems to provided effective postoperative analgesia for midline laparotomy with minimal or no opioid needs.