Analgesia in Major Abdominal Surgery

Successful enhanced recovery after surgery relies on early mobilisation and nutrition. The former relies on effective analgesia, which also indirectly affects the latter. Effective analgesia is a primary technique which when combined with maximal multimodal analgesia, provides adequate pain relief without motor blockade, urinary retention and hypotension whilst avoiding high dose systemic opiate, and its antecedent side effects. Other attributes required for widespread application of a technique are safety, lack of cumbersome attachments, minimal contraindications and ease of deployment and training. The resurgence of the forgotten technique of rectus sheath blockade, improved by the recent ability to prolong the block by bilateral catheter insertion in the rectus sheath space, may satisfy all the requirements of effective analgesia for patients undergoing open midline abdominal surgery. These catheters can be placed prior to surgery under ultrasound guidance or directly by the surgeon. Furthermore, they may also be placed postoperatively under ultrasound guidance on the intensive care unit prior to waking patients who have been ventilated following emergency surgery