SP1.1.12Post laparotomy rectal sheath catheter analgesia, systematic review

Midline laparotomy is still performed in high proportion of patients during elective and emergency procedures. Effective analgesia is essential for enhanced recovery programs especially with the focus of multi-modal opioid sparing analgesia with its benefits in reducing opiate related side effects. Many centres adopted the use of rectal sheath catheters (RSC) in all patients undergoing laparotomy, yet its use not been standardised as there is no hard evidence supporting its use. We aim from this systematic review to explore the effectiveness of RSC in post laparotomy analgesia and to compare between different techniques of insertion. We performed a systematic review in accordance with PRISMA standards. Search of electronic information data base (Medline, Embase, Cochrane, Library, Dynamed). Results (45) studies reviewed. (33) included with (1326) patients. Conclusion There is lack of high level evidence investigating RSC rule in post laparotomy analgesia, nonetheless which is the most effective technique (USS vs surgically inserted), in spite of large heterogeneity in methodology and scarcity of trials; the consensus of the reviewed studies concluded that it decreases opiates requirements by at least (70%) in patients receiving PCA and as good as ED but with less side effects.

Modified technique of extraperitoneal colostomy without incision of the posterior rectus sheath

Extraperitoneal colostomy is a widely used technique during abdominoperineal resection (APR) operation for lower rectal cancer. This technique has been reported to be effective to prevent the postoperative parastomal hernia in some retrospective studies, however, there is still a certain incidence of parastomal hernia. A modification of the extraperitoneal colostomy technique is described in this paper that keeps posterior rectal sheath intact instead of having a conventional incision, to further reduce the risk of parastomal hernia. Until now, this modified technique has been performed in 15 patients, no occurrence of parastomal hernia was observed.

Unusual Site Hemorrhagic Complications of Anticoagulantion

Anticoagulation has inherent quality to produce bleeding complications, more frequently in the elderly. Usual sites following anticoagulation is gastrointestinal, nasal, intracranial hemorrhage or petechial bleed. Here were reporting unusual sites of anticoagulation induced bleed. Rectus sheath hematoma is an unusual bleeding site, can mimic acute abdomen. Bleeding into intestinal wall can produce intussusception and presentation will be again as acute abdomen. Similarly, Sub lingual space is an unexpected site of bleeding and can present as upper airway obstruction or esophageal obstruction. Here we report one case of rectal sheath hematoma, 2 cases of sublingual hematoma and one case in the intestinal wall hematoma due to oral anticoagulation.