The Use of Rectus Sheath Catheters as an Analgesic Technique for Patients Undergoing Radical Cystectomy

Abstract

Introduction: Despite improvements in peri-operative care and the recent introduction of enhanced recovery protocols, radical cystectomy continues to be associated with a greater morbidity and a more prolonged in-patient stay than other urological procedures. There is significant scope for improvement and it is now well recognised that the analgesic technique used can impact on post-operative recovery. In this paper, we report on our early experience of using bilateral rectus sheath catheters (RSC) and highlight potential benefits of the technique. Methods: Over a 12-month period between November 2007 and November 2008, 20 patients underwent a radical cystectomy performed by a single surgeon and anaesthetist. Ten patients had bilateral rectus sheath catheters sited under ultrasound-guidance and they were compared to a preceding group of 10 patients who had epidural catheters inserted. Data were analysed retrospectively and primary outcome measures included pain scores, ileus rates, time to bowel opening and length of stay. Results: The demographics of the two groups showed no significant differences. Analgesic effect was equivalent between the groups. The time to passage of flatus and bowel opening was similar between the 2 groups. There was a slightly lower ileus rate and a shorter median length of stay in the RSC group (13 vs. 15 days) though the data are non-randomised and case numbers were small. Practical benefits in the placement and post-operative care of the RSCs were also observed. Conclusion: The rectus sheath block is a novel analgesic technique that appears to have an equivalent analgesic effect to epidurals in this early observational case series. RSCs have other potential advantages including earlier mobilisation and reduced burden on nursing and medical staff, thus making it ideally suited to an enhanced recovery protocol. Larger studies are needed to confirm the findings of the current case series.