Thoracic Epidural Anaesthesia as effective as Rectus Sheath Catheter Analgesia for pain reduction after major abdominal operations

Although it has long been a problem, postoperative pain management is a basic human right. Because of the size of the abdominal wall incision, laparotomies, which entail considerable levels of postoperative discomfort, are often associated with postoperative pain. With an emphasis on early mobilisation and enteral or oral feeding, enhanced recovery procedures seek to reduce morbidity and hasten functional recovery. To provide the best possible surgical recovery, effective analgesia is essential for lowering stress, enabling patient mobility, enhancing respiratory function, and preventing gastrointestinal issues. Inadequate pain management has the potential to worsen physical function, raise morbidity, lower quality of life, and delay healing. Pain may impair the functioning of many organ systems, change the immune system, and interfere with the healing of wounds. Inadequate pain management may lead to longer hospital stays, greater readmission rates, and higher overall healthcare expenses.

Overuse of systemic opioid analgesia is linked to a high rate of postoperative adverse effects, including constipation, urine retention, itching, pseudo-obstruction or ileus, excessive sedation, and reduced respiratory function. Rectus sheath catheters (RSC) relieve anterior abdominal wall tissues' discomfort during treatments that call for a midline incision. Recently published research evaluated how well thoracic epidural analgesia (TEA) and rectal sheath catheter (RSC) relieve pain after major abdominal surgery.

The chi-squared test and I2 test were utilised in the study's statistical analysis, which was conducted using the RevMan 5.3 software programme. The random effect model analysis was performed using the Mantel-Haenszel technique to determine the relative risk. Postoperative pain ratings at rest and during movement after 24 hours were the main goal, while postoperative pain scores at rest and during movement after 48 hours after the laparotomy were the secondary endpoint.

Four RCTs with 351 patients, carried out between 2017 and 2022, were included in the meta-analysis. The patients' ages varied from 47.53 ± 9.43 to 67 years old on average. Table 1 displays the key features of the included research, and Table 2 displays the analgesic method used in each study.

Four RCTs on rectal sheath catheter (RSC) surgery and thoracic epidural analgesia (TEA) were included in the research. The analgesic approach, the kind of operation, and the surgery itself are the primary features of the studies that are included. Also included was the analgesic method used in each experiment.

The study's conclusion was that TEA was superior than RSC in terms of minimising pain after laparotomy; also, the analgesic method used in each experiment was examined.

In this systematic review, four Randomised Controlled Trials (RCTs) involving 351 patients undergoing open major abdominal surgery were examined. The results showed that there was no significant difference in VAS pain scores at rest and during movement between thoracic epidural analgesia (TEA) and rectal sheath catheter (RSC) after 24 and 48 hours. There was no discernible change in pain levels between the two groups, according to the random effect model analysis. Significant heterogeneity, on the other hand, was seen throughout the trials that were included, suggesting that the included research are inconsistent for reasons other than chance.

The research has a few limitations, but its conclusions are consistent with those of other meta-analyses on the topic. There are just four RCTs on 351 individuals in the study, which is regarded as a modest number. To adequately evaluate the success of any analgesic treatment, other factors including the requirement for further analgesics and the impact on the patient's shoulder's functional condition must be taken into account. When comparing analgesic modalities, it is important to take into account the safety of each one as well as any potential adverse effects.

Conclusion: Based on almost identical VAS pain ratings at 24 and 48 hours during both rest and movement stages, there is no discernible difference between the use of TEA and RSC for pain reduction after major abdominal operations. However, the safety of these approaches was not investigated because of the study's limitations. To ascertain whether mode of analgesia is safer and more effective for postoperative pain management in patients after major abdominal surgery, a multicenter randomised controlled trial (RCT) with a large sample population is recommended. This RCT compares all components of a successful mode of analgesia.

Reference –

Nour H M, Elmansi Abdalla H E, Abogabal S, et al. (November 15, 2023) Comparing Thoracic Epidural Anaesthesia to Rectus Sheath Catheter Analgesia for Postoperative Pain After Major Abdominal Surgeries: A Systematic Review. Cureus 15(11): e48842. doi:10.7759/cureus.48842