MTP6.05 Comparison of wound infusion catheters verses epidural catheters for analgesia after midline laparotomy

Abstract Aim Anaesthetic infusion through wound catheters has been reported to lessen opiates use and its morbidity. Our meta-analysis evaluates effectiveness and safety continuous wound infusion catheter (WC) versus Epidural infusion (EP) for analgesia after laparotomy for major abdominal surgery. Methods A systematic search of the literature database was conducted. All Randomised controlled trials (RCTs) comparing WC to EP for analgesia after midline laparotomy were included. Overall pain scores, total morphine consumption, respiratory depression, catheter-related complications, time of first bowel movement, and Length of hospital stay (LOS) were set as outcome parameters for the meta-analysis. Results Thirteen RCTs, studying a total of 817 patients, were included. Pooled pain scores from nine RCTs showed no statistical significant difference at rest (MD 0.14, P=0.37) and on movement (MD 0.32, P=0.50). On leave-one-out analysis, excluding subcutaneous wound catheters, a significant difference was notable in pain scores at 48 hours on movement, favouring WC group (MD -0.97, P=0.03). WC group showed less morphine consumption [P=0.02] and shorter LOS [P= 0.0001] compared to the EP group. Moreover, there was no significant difference between the two groups regarding the time of first bowel movement [odd ratio (OR) 0.14, P=0.19], catheter-related complications [OR 0.48, P= 0.11] and postoperative respiratory depression [OR 0.79, P=0.53]. Conclusions WC provides comparable postoperative analgesia to EP; however, it is associated lower opiates consumption and shorter hospital stay following midline laparotomy. Future research to focus on optimal position for wound catheters and standarisation of the technique and analgesic regime.