TEA or RSCA which is better postoperative analgesic option in open midline major abdominal surgery?
UK: Thoracic epidural analgesia (TEA) as compared to rectus sheath catheter analgesia (RSCA) provides superior initial postoperative analgesia after laparotomy but only for the first 24 h, says a study published in BJS Open. By 72 hours, however, RSCA provided superior analgesia, was tied to a lower incidence of unwanted effects and was more cost-effective.
Both rectus sheath catheter analgesia and thoracic epidural analgesia are used for analgesia after laparotomy. Anton Krige, Department of Anaesthesia and Critical Care, Royal Blackburn Teaching Hospital, Blackburn, UK, and colleagues aimed to compare the analgesic effect of RSCA with TEA after laparotomy for elective colorectal and urological surgery.
For this purpose, the researchers included patients undergoing elective midline laparotomy. They were randomized to receive RSCA or TEA for postoperative analgesia at a single UK teaching hospital. Dynamic pain score at 24 h after surgery was the primary quantitative outcome measure.
The dual primary outcome of patient acceptability and experience was explored by a nested qualitative study (reported elsewhere). Secondary outcome measures were rest and movement pain scores over 72 h, analgesia satisfaction, functional analgesia, functional recovery, opiate consumption, safety, morbidity, and cost-effectiveness.
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