Advertisement

International Journal of Colorectal Disease

, Volume 34, Issue 7, pp 1345–1348 | Cite as

Rectus sheath catheters—a novel approach to perioperative analgesia for colorectal surgery in an enhanced recovery after surgery (ERAS) protocol: a case series

  • David RotsteinEmail author
  • Chang Park
  • Sergey Khaitov
  • Elisha Dickstein
Case Report
  • 56 Downloads

Abstract

Introduction

Opioids have played a critical role in the management of perioperative pain following abdominal surgery. Increasing attention is being paid to the deleterious side effects and limitations of this practice. This case report offers a novel alternative to opioid-based analgesia in the form of rectus sheath catheters (RSCs) which we employed as part of an enhanced recovery after surgery (ERAS) protocol.

Methods

Three patients underwent laparoscopic- assisted colorectal surgery and were treated intra- and postoperatively with local anesthesia administered via bilateral rectus sheath catheters as well as by multimodal adjuncts. Evaluations of the patients’ pain scores, opioid usage, and abdominal sensitivity to sharp stimuli were conducted daily.

Results

The patients demonstrated a substantially lessened opioid requirement over their hospital stay with two of them requiring no opioid analgesic medications postoperatively.

Discussion

We suggest that the incorporation of these catheters into an ERAS protocol can play an important role in further reducing perioperative opioid usage for procedures in which pain control can be especially challenging.

Keywords

Regional Catheter Pain Opioids ERAS 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery. 149(6):830–840CrossRefGoogle Scholar
  2. 2.
    Kehlet H, Dahl JB (1993) The value of “multimodal” or “balanced analgesia” in post-operative pain treatment. Anesth Analg 77:1048–1056CrossRefGoogle Scholar
  3. 3.
    Rosse C, Gaddum-Rosse P (1997) Hollinshead’s textbook of anatomy, 5th edn. Lippincott-Raven, Philadelphia, PAGoogle Scholar
  4. 4.
    Koh WU, Lee JH (2018) Ultrasound-guided truncal blocks for perioperative analgesia. Anesth Pain Med 13(2):128–142CrossRefGoogle Scholar
  5. 5.
    Yassin HM, Abd elmoneim AT, El moutaz H (2017) The analgesic efficiency of ultrasound-guided rectus sheath analgesia compared with low thoracic epidural analgesia after elective abdominal surgery with a midline incision: a prospective randomized controlled trial. Anesth Pain Med. 7(3):e14244CrossRefGoogle Scholar
  6. 6.
    Cornish P, Deacon A (2007) Rectus sheath catheters for continuous analgesia after upper abdominal surgery. ANZ J Surg 77(1–2):84CrossRefGoogle Scholar
  7. 7.
    Sandeman D, Dilley A (2008) Ultrasound-guided rectus sheath block and catheter placement. ANZ J Surg 78:621–623CrossRefGoogle Scholar
  8. 8.
    Winnie AP, Buckheoj P, Hoakansson L (1994) Plexus anesthesia: perivascular techniques of brachial plexus block, revised edn. Saunders, Philadelphia, PAGoogle Scholar
  9. 9.
    Malchow R, Jaeger L, Lam H (2011) Rectus sheath catheters for continuous analgesia after laparotomy--without postoperative opiate use. Pain Med 12(7):1124–1129CrossRefGoogle Scholar
  10. 10.
    Bakshi S, Mapari A, Paliwal R (2015) Ultrasound-guided rectus sheath catheters: a feasible and effective, opioid-sparing, post-operative pain management technique: a case series. Indian J Anaesth 59(2):118–120CrossRefGoogle Scholar
  11. 11.
    Bielefeld K, Davis B, Binion DG (2009) Pain and inflammatory bowel disease. Inflamm Bowel Dis 15(5):778–788CrossRefGoogle Scholar
  12. 12.
    Hakkarainen TW, Steele SR, Bastaworous A, Dellinger EP, Farrokhi E, Farjah F, Florence M, Helton S, Horton M, Pietro M, Varghese TK, Flum DR (2015) Nonsteroidal anti-inflammatory drugs and the risk for anastomotic failure: a report from Washington State’s Surgical Care and Outcomes Assessment Program (SCOAP). JAMA Surg 150(3):223–228CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • David Rotstein
    • 1
    Email author
  • Chang Park
    • 1
  • Sergey Khaitov
    • 2
  • Elisha Dickstein
    • 1
  1. 1.Department of Anesthesiology, Perioperative, and Pain MedicineIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Department of SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA

Personalised recommendations