First Experience With Rectus Sheath Block for Postoperative Analgesia After Pancreas Transplant: A Retrospective...

Area of Science:

• Anesthesiology
• Transplant Surgery
• Pain Management

Background:

• Thoracic epidural analgesia (TEA) was the standard for postoperative pain relief after pancreas transplants.
• A shift to aggressive anticoagulation protocols due to high venous graft thrombosis rates necessitated a safer analgesia method.
• Rectus sheath block (RSB) was adopted in 2017 to mitigate the risk of epidural hemorrhage.

Purpose of the Study:

• To compare the efficacy and safety of rectus sheath block (RSB) versus thoracic epidural analgesia (TEA) for postoperative pain management in pancreas transplant patients.
• To evaluate pain control, opioid consumption, and complication rates between the two analgesic techniques.

Main Methods:

• A comparative study included 29 pancreas transplant recipients from June 2016 to December 2017.
• Sixteen patients received TEA, while 13 received ultrasound-guided bilateral RSB with catheter insertion.
• Both groups received multimodal analgesia including acetaminophen, rescue opioids, and intermittent local anesthetic or continuous epidural infusions.

Main Results:

• No significant difference in the amount of intravenous morphine equivalents (MEQ) consumed between the RSB and TEA groups.
• RSB catheters remained in place significantly longer than TEA catheters.
• Both techniques demonstrated good patient satisfaction and comfort, with no reported complications.

Conclusions:

• Rectus sheath block (RSB) is an equally effective and safe alternative to thoracic epidural analgesia (TEA) for postoperative pain management in pancreas transplant patients.
• RSB is particularly suitable for patients requiring aggressive anticoagulation, reducing the risk of bleeding complications associated with TEA.