REctus Sheath block for postoperative analgesia in gynecological ONcology Surgery (RESONS): a randomized-controlled trial.

REctus Sheath block for postoperative analgesia in gynecological ONcology Surgery (RESONS): a randomized-controlled trial.

Bakshi SG, Mapari A, Shylasree TS.REctus Sheath block for postoperative analgesia in gynecological ONcology Surgery (RESONS): a randomized-controlled trial. Anaesth. 2016 Dec;63(12):1335-1344.

What is already known:
Epidurals are often considered the gold standard when it comes to post-operative analgesia in open surgery. However, a lot of the evidence for this comes from the pre-ERAS era. There are also associated complications for example hypotension and muscle weakness, which can affect early mobilisation. Together with a consistent associated failure rate, this has given rise to a great deal of interest in different analgesic techniques in particular for open surgery.

What this paper adds:

This is a small RCT of patients undergoing an ERAS programme for open midline gynae-oncology surgery using Rectus Sheath catheters, randomised to receive either local anaesthetic or normal saline alongside a morphine PCA. Unsurprisingly the local anaesthetic group had better pain scores and had a significant morphine sparing effect. This group were also able to mobilise sooner and had an earlier return to bowel function, suggesting that rectus sheath analgesia could be an alternative analgesic modality. Although doesn’t answer the question of what is the optimal analgesia for open midline surgery within a comprehensive ERAS programme.

Chris Jones, Guildford. @chrisnjones