Rectus sheath catheters for postoperative analgesia following paediatric midline laparotomy

a randomised controlled trial

Summary

Abdominal surgery is one of the most common paediatric inpatient operations. Often performed in the emergency setting, paediatric laparotomy is an abdominal operation requiring a large, vertical midline incision. It is crucial to managing life-threatening intra-abdominal conditions including bowel obstruction, volvulus, and infection. Given the nature of the incision, laparotomy is known to cause severe post-operative pain and thus has a high analgesic requirement.

Intravenous opioids via nurse or patient controlled analgesia (NCA or PCA) pumps are commonly used to treat post-operative pain following paediatric laparotomy. Although effective, systemic opioids have a number of unwanted side effects, including nausea, sedation and reduced bowel motility.

Rectus sheath catheters (RSCs) are a promising modality for providing opioid-sparing pain relief following midline laparotomy. Local anaesthetic, infused into the rectus sheath, provides sensory blockade to the rectus abdominis and overlying skin. Despite increasing popularity in adults, no clinical trials have been conducted in the paediatric population, therefore evidence for RSC use in children is scarce. Furthermore, there is no agreed consensus on the most effective modality for post-operative analgesia in paediatric midline laparotomy.

We aim to design a pragmatic randomised controlled trial (RCT) to assess the clinical and cost effectiveness of RSCs in this population. Our future NIHR HTA grant will be for a multicentre placebo-controlled RCT comparing RSCs to standard opioid analgesia. The population will be children (6 months - 16 years) undergoing midline laparotomy. Our proposed primary outcomes are resting pain scores and opioid consumption (via NCA/PCA) at 24 hours post-operatively.