title: Rectus sheath catheters for continuous analgesia after laparotomy--without postoperative opioid use.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical Center, The Vanderbilt Clinic, Nashville, TN 37232-5614, USA. randall.malchow@vanderbilt.edu
authors.forename: Randall
authors.initials: R
authors.lastname: Malchow
authors.forename: Lisa
authors.initials: L
authors.lastname: Jaeger
authors.forename: Humphrey
authors.initials: H
authors.lastname: Lam
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D057785:Catheters; D005260:Female; D006801:Humans; D007813:Laparotomy; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017568:Rectus Abdominis / Q000033:anatomy & histology*
chemical_list: D000701:Analgesics, Opioid