Rectus sheath catheters in patients undergoing laparotomy

Effective analgesia following midline laparotomy is crucial for recovery but its use remains challenging. Whilst thoracic epidurals have been the traditional gold standard, they are associated with complications such as hypotension, motor blockade and failure. This article presents a vignette of a 69-year-old woman who underwent ovarian cancer debulking and received a multimodal analgesic regimen, including spinal anaesthesia and bilateral rectus sheath catheters. Here, we review the relevant anatomy, insertion techniques, local anaesthetic dosing regimens and current evidence for rectus sheath catheters. Results indicated that rectus sheath catheters, when combined with other multimodal analgesic techniques, provide analgesia non-inferior to epidurals with superior hemodynamic stability. Therefore, rectus sheath catheters represent a safe, effective option within a multimodal analgesic plan for major abdominal surgery.