title: Ultrasonography guided rectus sheath catheters versus epidural analgesia for open colorectal cancer surgery in a single centre.
abstract: BACKGROUND
  Epidural anaesthesia (EA) has been the accepted standard for postoperative analgesia in open abdominal surgery. However, it is not without significant risk. This study aimed to audit the effect of EA and ultrasonography placed rectus sheath catheters (RSCs) on analgesia as well as the incidence of postoperative complications following open colorectal cancer surgery.
  
  
  METHODS
  A three-year retrospective case note review was undertaken of all patients undergoing open colorectal cancer surgery at the Royal Devon and Exeter Hospital NHS Foundation Trust who received either EA or RSC for postoperative analgesia under the care of the senior authors. A single surgeon and single anaesthetist were practitioners.
  
  
  RESULTS
  The case notes of 120 patients were reviewed retrospectively: 85 patients had EA and 24 RSC while 11 patients were excluded from the study. The EA group experienced a significantly higher incidence of hypotension (systolic blood pressure <130 mmHg) than the RSC group on the first postoperative day (p=0.0001). There was no significant difference in pain score or opiate sparing properties between the groups (p=0.92). There was no significant difference in postoperative respiratory tract infection, anastomotic leak or wound complications between the groups (p=0.2, p=1.0 and p=0.5 respectively). The RSC group had a higher incidence of ileus than the EA group (4/24 vs 2/85, p=0.026). However, the numbers were too small to draw a reliable conclusion.
  
  
  CONCLUSIONS
  The use of ultrasonography guided RSCs has demonstrated effective postoperative analgesia equivalent to EA with the potential benefits of a reduced incidence of hypotension. A prospective randomised trial is now underway to compare RSC and EA in open abdominal and pelvic surgery.
authors.affiliation: Royal Devon and Exeter Hospital NHS Foundation Trust, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Godden
authors.forename: M J
authors.initials: MJ
authors.lastname: Marshall
authors.forename: A S
authors.initials: AS
authors.lastname: Grice
authors.forename: I R
authors.initials: IR
authors.lastname: Daniels
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000295:instrumentation* / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology; D002404:Catheterization / Q000379:methods*; D057785:Catheters; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D045823:Ileus / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods; D012141:Respiratory Tract Infections / Q000209:etiology; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D018084:Ultrasonography, Interventional; D055815:Young Adult