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


Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1010, New York, NY, 10029, USA. [Email]


BACKGROUND : 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.
CONCLUSIONS : 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.