Official websites use. Share sensitive information only on official, secure websites. Opioid-sparing pain management is an integral component of enhanced recovery after colonic and rectal surgery. In our hospital, rectus sheath catheters RSCs are routinely placed during emergency laparotomy for colorectal procedures to allow a postoperative compartmental block of the surgical site with repeated doses of bupivacaine.
We present a quality improvement project in which we administered single-shot liposomal bupivacaine LB intraoperatively as an alternative to bolus doses of conventional bupivacaine delivered through RSCs. Having thereby reduced the demands placed on nursing time through a reduction in the use of RSCs, we sought to establish whether there was any associated change in analgesic efficacy. Patient pain scores, use of patient-controlled analgesia PCA and length of stay following surgery were analysed before and after the introduction of LB.
No disruption in these outcomes was identified using statistical process control analysis. The median length of stay for patients who received LB was We conclude that LB represents a viable alternative to boluses of conventional bupivacaine via RSCs in promoting enhanced recovery after emergency laparotomy and look to extend its use locally. Following laparotomy, repeated injections of bupivacaine through rectus sheath catheters are an effective means of providing non-opiate analgesia.
Single-shot liposomal bupivacaine offers an alternative to regular doses of conventional bupivacaine given through a rectus sheath catheter. The introduction of liposomal bupivacaine in place of rectus sheath catheters does not compromise the pain management of patients who have undergone emergency laparotomies.
The analgesic efficacy of liposomal bupivacaine should be compared with that of rectus sheath catheters in prospective, controlled, randomised trials. Over the past 15 years, rectus sheath catheters RSCs have emerged as an analgesic modality to provide non-opiate analgesia following major abdominal surgery, offering advantages over thoracic epidural in terms of their side effect profile. A disadvantage to the use of RSCs is that their maintenance is a drain on nursing resources.
