Analgesia for Mid-line Laparotomies: Thoracic Epidural vs Restus Sheath Analgesia

Midline laparotomies are accompanied by severe postoperative pain. Adequate post-operative pain relief after major abdominal surgery reduces complications (e.g. chest infection or deep venous thrombosis) and enhances recovery and early mobilization, with better patients\' satisfaction, and less hospital stay. The standard technique for post-operative analgesia after major abdominal surgery is thoracic epidural analgesia (TEA). On the other hand, the complications encountered with TEA motivates the search for another technique, besides that in some situations, midline incision is needed while TEA is contraindicated e.g. emergency laparotomy. Rectus sheath nerve block (RSB) is a regional anesthetic technique that provides midline somatic analgesia and might be an alternative to TEA. It is an old technique that has been revisited because of the availability of new local anesthetic agents, and the availability of small-caliber catheters. It was hypothesized that rectus sheath analgesia (RSA) might be an alternative to thoracic epidural analgesia. Thereby, the aim of the current study is to find whether analgesia provided through surgically placed rectus sheath catheters can be a safe and effective alternative to thoracic epidural analgesia for postoperative pain relief in patients undergoing elective midline laparotomies.