Title : Effect of local anesthetic infiltration via rectus sheath catheter in general surgical patients undergoing laparotomy - A retrospective audit
Abstract:
Background : Effective multi-modal analgesia post laparotomy facilitates early mobilisation and return to function after major surgery and is a significant component of Enhanced Recovery After Surgery (ERAS) programmes. Local anaesthetic infusion with Rectus Sheath Catheters are known to provide effective post-laparotomy analgesia. Avoiding some of the side-effects associated with opioid and thoracic epidural techniques.
objectives:
• This audit retrospectively looks into data from last 3 years of 40 patients who had surgeon inserted Rectus Sheath Catheters after elective and emergency laparotomies in Peterborough City Hospital.
• The aim of this audit is to compare current practice against the set Trust Guidelines for the use of local anaesthetic infusion via a catheter for the management of pain in adults:
1-As part of a multimodal approach to analgesia to decrease opiate requirements (reducing the risk of side effects) and to potentiate more rapid mobilisation.
2-The Local Anaesthetic should prescribed on the Trust specific LA infusion chart (SF0974) .
3-Prior to discontinuation of the LA infusion alternative analgesia should be prescribed both regularly and when required.
4-LA infusion catheters should be removed on the 3rd to 5th post-operative day or sooner. Plans to extend usage of an LA infusion will be made only by the acute pain service.
Methods :
• 40 patients who underwent laparotomy and had rectus sheath catheter inserted over the last 3 years by a single surgeon in PCH. • Data was collected retrospectively from E-Track and Evolve. Results:( referencing to the trust guidelines )
1-Only 50% of patients required PCA with rectus sheath catheters post laparotomy(Of those patients who had PCA, mean duration of PCA is 2.1 days).
2-The SF0974 chart was only introduced in 2020, all the patients (100%) since then has had the form prescribed.
3-All patients (100%) had regular and PRN analgesia prescribed after LA infusion had been stopped.
4-39 patients had their rectus sheath catheter removed within 5 days.
Only 1 patient had their rectus sheath catheter removed on Day 6, which was not advised by acute pain service. Conclusions: Full compliance with trust guidelines measures (1-3) but improvement required regarding measure (4) and the recommendation was Patients requiring rectus sheath catheters over 5 days post-op laparotomy should be formally assessed by acute pain team as stated in the trust guidelines.
Conclusions: Full compliance with trust guidelines measures (1-3) but improvement required regarding measure (4) and the recommendation was Patients requiring rectus sheath catheters over 5 days post-op laparotomy should be formally assessed by acute pain team as stated in the trust guidelines.
