Are rectus sheath catheters being placed accurately into optimum position during NELA laparotomies?

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Authors
Waddell, Kate
Nevins, Edward
McCalluim, Iain
Issue Date
2023
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Abstract
"Introduction: Rectus sheath catheters (RSC) are a method of delivering local anaesthetic to post-operative laparotomy wounds. Ideal standard positioning for RSC's is in the retro-rectus space. They aim to reduce post-operative pain, and show less side effects than epidural analgesia. This audit reviews positioning of RSC in post-operative laparotomy patients at a centre in North East England. Methods: All NELA (National Emergency Laparotomy Audit) patients who had open laparotomy or laparoscopic converted to open procedures between 1st December 2021 to September 2022 were identified and included. Patients who had both RSC inserted and had a CT scan within the first 3 post-operative days were identified. Results: 105 patients (68%) had RSC inserted. 11 (10.5%) patients with RSC placed had post-operative imaging within 3 days. CT images were reviewed assessing the position of RSC's. One patient had bilateral RSC correctly placed. Of the total individual RSC's (22) on imaging, 9 were correctly positioned, 9 incorrectly positioned, and 4 not identified when reviewing CT images. All of those incorrectly positioned were identified in the subcutaneous fat. Conclusion: At this hospital in North East England, surgeons insert RSC and do not use ultrasound guidance. This audit highlighted that they are mostly placed in the incorrect position. Ultrasound guided insertion could be considered as a method of inserting RSC more accurately. Further research is needed to assess if correctly placed RSC."
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Citation
Waddell, K., Nevins, E. and McCallum, I. (2023) Are rectus sheath catheters being placed accurately into optimum position during NELA laparotomies? British Journal of Surgery; 110 (supp_3) : znad101.053.
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British Journal of Surgery
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https://hdl.handle.net/20.500.14445/1038
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https://doi.org/10.1093/bjs/znad101.053
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1365-2168
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Surgery