Abdominal wall catheters for postoperative analgesia

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 4 – P O S T O P E R AT I V E C A R E

Abdominal Wall Catheters for Postoperative Analgesia Shawky M et al. Abdominal wall catheters for postoperative analgesia in patients undergoing open gynaecological procedures. TOG 2025;27:115–121. doi:10.1111/tog.12971

1.8/100,000 11/37 vs 0/36 Up to 7 days EPIDURAL PARAPLEGIA/DEATH RISK ADVERSE EVENTS: EPIDURAL VS RSC TUNNELLED RSC DWELL TIME

DO N' T-M IS S FA C TS

  1. Epidural catastrophic complication risk: 1.8/100,000 (paraplegia/death); hypotension requiring intervention RR 7.13 vs RSC/PCA.

  2. RCT: adverse events 11/37 epidural vs 0/36 RSC — no difference in rescue analgesia use.

  3. Midline incision → RSC (rectus sheath, posterior to rectus muscle); Pfannenstiel → TAP block (between IO and TA).

  4. Contraindications to RSC: coagulopathy, insertion-site infection, LA allergy, patient refusal.

  5. Bolus regimen: 20 ml LA every 6h (levobupivacaine 0.25% / ropivacaine 0.2% / bupivacaine 0.25%), only if >50 kg.

  6. LAST early signs: confusion, tinnitus, diplopia, perioral numbness → have Intralipid/lipid rescue protocol ready; always aspirate before each injection.

  7. Tunnelled RSC dwell time up to 7 days; typical removal days 2–3 after a "trial without top-up".

  8. Direct surgical placement risk: catheter often misplaced extraperitoneally rather than superior to transversalis fascia, reducing efficacy.

TECHNIQUE MATCHED TO INCISION

Midline → RSC (posterior to rectus muscle) Pfannenstiel → TAP block (IO/TA plane)

Avoid RSC: coagulopathy, site infection, LA allergy

ABBREVIATION KEY

ERAS — enhanced recovery after surgery TA — transversus abdominis (muscle)

PCA — patient-controlled analgesia TF — transversalis fascia

IV — intravenous PP — parietal peritoneum

CI — confidence interval BMI — body mass index

RSC — rectus sheath catheter LAST — local anaesthetic systemic toxicity

TAP — transversus abdominis plane RCT — randomised controlled trial

LA — local anaesthetic RR — relative risk

EO — external oblique (muscle) G — gauge (needle/cannula size)

IO — internal oblique (muscle)

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — TOG 2025;27:115–121. doi:10.1111/tog.12971

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