A PILOT STUDY OF RECTUS SHEATH CATHETERS FOR RADICAL RETROPUBIC PROSTATECTOMY
P.B. Cornish, P. Pullar, S. Rhondeau, A. Southwick, A. Malcolm, P. Meffan
Nelson Hospital, Nelson, New Zealand
Introduction
Amidst concerns over risk/benefit profile, an alternative strategy to epidural analgesia for abdominal surgery such as continuous abdominal wall analgesia 1,2 could be useful.
Method
With IRB approval, 20 patients undergoing radical retropubic prostatectomy via a vertical infraumbilical incision were enrolled in the study. General anaesthesia was employed, using N2O, volatile agent, muscle relaxant and opioid (Fentanyl 100-200 microg at induction and Morphine 10-20 mg during the procedure). During closure of the abdominal wound, incisions were made into each rectus sheath and a 16 gauge epidural catheter laid onto the anterior belly of each muscle, then exited through the skin lateral to the wound using a 16 gauge Tuohy needle. Each catheter was dosed with 20 ml 0.25% Bupivacaine + 1:400,000 adrenalin (BIB), administered 4-6 hourly for the next 24 hours, then prn. Morphine was available in PACU and thereafter, 2 mg iv q 5mins prn until VAS<2/10. Patients also had regular paracetamol, voltaren, and tramadol prn. VAS pain score was recorded 30 minutes after BIB each day.
Result
Intraoperative morphine - 11±6 mg; PACU morphine 6±7 mg; Morphine after midnight 1st postoperative night : 2±6 mg; Total Perioperative Morphine - 20±10 mg; VAS Day 1 postop: rest – 0.5±0.9, cough – 1.6±2.0; BIB - 10±2; Tramadol - 585±545 mg. Days in hospital:3±1 days
Conclusion
The rectus sheath catheters were effective at controlling the abdominal wall pain. Visceral pain from the operative bed required morphine in the early postoperative phase, but this need rapidly diminished. This system warrants further study.
Time of Presentation
Sunday 14 May 2006 - 1030-1200
References
1. Watson D, Farquhar IK, Dennison AR et al. BJA 67, 656P
2. Cornish P, Anderson B, Chambers C. Paediatr Anaesth 1993;3:191-2
