Thoracic Epidural versus Surgically placed Rectus Sheath Catheters for Postoperative Analgesia after Midline Laparotomies: A Randomized clinical Trial

Background: Midline laparotomies are accompanied by severe postoperative pain that is mainly related to abdominal wall incision. Objective: This study aimed to find if the analgesia provided through rectus sheath catheters can be safe and effective as thoracic epidural analgesia for early postoperative pain relief after midline laparotomies.
Patients and Method: 50 patients were randomly allocated into 2 groups: Group TEA (n=25): on wound closure 20 mL of 0.25% bupivacaine + 40 μg fentanyl were injected into epidural catheter. Thereafter, every 6 h, 20 mL 0.125% bupivacaine + 40 μg Fentanyl for 48 h were injected into the catheter. Group RSB (n=25): bilateral rectus sheaths catheters were surgically placed during wound closure. On each side, 20 mL bupivacaine 0.125% + 20 μg fentanyl were injected. Then, every 6 h, 10 mL 0.125% bupivacaine + 20 μg fentanyl were given through each catheter for 48 h. In both groups, IV 1 gm paracetamol/8h was given. If visual analogue scale (VAS) score became ≥ 4. Also, IV fentanyl was given.  Results: intraoperative and postoperative fentanyl consumption, time to first analgesia, VAS and sedation levels were comparable between groups. Time for first oral intake was shorter in group TEA. Time for independent ambulation was shorter in group RSB. Post-operative nausea and vomiting (PONV) and pruritus were higher in group TEA. Patients' satisfaction was higher in group RSB.
Conclusion: Analgesia through surgically placed rectus sheath catheters is a safe and effective alternative to thoracic epidural analgesia in midline laparotomies. Clinical trials registration number: NCT04262622.