Rectus Sheath Catheters for Continuous Analgesia after Laparotomy-Without Postoperative Opioid Use

Objective. Opioid and epidural analgesia have been the mainstay for postoperative pain control following laparotomies, yet have many potential side effects, risks, and limitations. This case report offers an alternative to opioid as well as epidural analgesia, which may be beneficial in some patients. Design. We report a case of a patient who underwent a laparotomy with extensive lysis of adhesions who was treated postoperatively with continuous bilateral rectus sheath catheters and multimodal adjuncts including gabapentin, clonidine, and nonsteroidal anti-inflammatories. Results. We successfully used a novel, multimodal approach that avoided the use of epidural analgesia and postoperative opioids. The patient was extremely satisfied, reported minimal discomfort, ambulated early, advanced her diet quickly, and was discharged home after a short hospital stay. Conclusions. This report may be the first description of a successful multimodal postoperative analgesic regimen including continuous bilateral rectus sheath blocks without inpatient postoperative opioid use or epidural analgesia following a midline laparotomy.