Key result
Rectus sheath catheter analgesia showed no significant difference in visual analogue scale pain scores at 24 hours at rest compared to thoracic epidural analgesia following major abdominal surgery.
Why the study?
Thoracic epidural analgesia is traditionally preferred for major abdominal surgery but has multiple complications, whereas rectus sheath catheter analgesia has been gaining popularity.
Does rectus sheath catheter analgesia improve postoperative pain compared to thoracic epidural analgesia in patients undergoing major abdominal surgery?
Meta-Analysis (n=351)
Does rectus sheath catheter analgesia improve postoperative pain compared to thoracic epidural analgesia in patients undergoing major abdominal surgery?
Rectus sheath catheter analgesia provides comparable postoperative pain relief to thoracic epidural analgesia following major abdominal surgery at 24 and 48 hours.
Answers are grounded in this paper and cite their sources.
Rectus sheath catheters provide equivalent analgesia to thoracic epidurals after major abdominal surgery; supports their adoption as a lower-risk alternative.
Controlling postoperative pain is essential for the greatest recovery following major abdominal surgery. Thoracic epidural analgesia (TEA) has traditionally been considered the preferred method of providing pain relief after major abdominal surgeries. Thoracic epidural analgesia has a wide range of complications, including residual motor blockade, hypotension, urine retention with the need for urinary catheterisation, tethering to infusion pumps, and occasional failure rates. In recent years, rectus sheath catheter (RSC) analgesia has been gaining popularity. The purpose of this review is to compare the effectiveness of TEA and RSC in reducing pain following major abdominal surgeries. Four randomised controlled trials (RCTs) reporting outcomes of the visual analogue scale (VAS) pain score were included according to the set criteria. A total of 351 patients undergoing major abdominal surgery were included in this meta-analysis. There were 176 patients in the TEA group and 175 patients in the RSC group. In the random effect model analysis, there was no significant difference in VAS pain score in 24 hours at rest (standardised mean difference (SMD) -0.46; 95% CI -1.21 to 0.29; z=1.20, P=0.23) and movement (SMD -0.64; 95% CI -1.69 to -0.14; z=1.19, P=0.23) between TEA and RSC. Similarly, there was no significant difference in pain score after 48 hours at rest (SMD -0.14; 95% CI -0.36 to 0.08; z=1.29, P=0.20) or movement (SMD -0.69; 95% CI -2.03 to 0.64; z=1.02, P=0.31). In conclusion, our findings show that there was no significant difference in pain score between TEA and RSC following major abdominal surgery, and we suggest that both approaches can be used effectively according to the choice and expertise available.
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Nour et al. (2023) conducted a meta-analysis in Postoperative pain after major abdominal surgeries (n=351). Rectus sheath catheter analgesia vs. Thoracic epidural analgesia was evaluated on Visual analogue scale (VAS) pain score in 24 hours at rest (SMD -0.46, 95% CI -1.21 to 0.29, p=0.23). Rectus sheath catheter analgesia showed no significant difference in visual analogue scale pain scores at 24 hours at rest compared to thoracic epidural analgesia following major abdominal surgery.
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