Introduction Wound infusion catheters are becoming increasingly popular to control post-operative pain as an alternative to thoracic epidurals, which have a significant failure rate and complication profile. The aim of this was to review our experience with the OnQ® (Bbraun) wound infusion catheter in patients undergoing elective and emergency colorectal laparotomy in terms of usage, safety and efficacy.
Method Retrospective analysis of a prospectively maintained database of all patients undergoing elective and emergency colorectal laparotomy at Leicester Royal Infirmary October 2013–2014. Emergency patients ventilated post-operatively were excluded. OnQ® wound catheters were inserted in the preperitoneal plane in combination with morphine PCA, and delivered levobupivicaine 0.25% 5 ml/hr for 56 h.
Results Since 2008, 727 patients have received wound catheters as analgesia following colorectal laparotomy. Complication rate was low (1.5%), mainly related to catheter displacement (n = 11). During the 12 month study period 179 patients underwent elective colorectal laparotomy. 120 of these had an OnQ® inserted (67%), with a significantly lower total morphine consumption compared to PCA alone (109 vs 193 mg p < 0.05 Mann-Whitney). 239 patients underwent emergency laparotomy during this period. Of these, only 28 had an OnQ® inserted (11%), again with a significantly lower total morphine consumption compared to PCA alone (92 vs. 154 mg p < 0.05 Mann-Whitney). The only complications directly related to the OnQ® during this period were due to catheter displacement (n = 2).
Conclusion Wound infusion catheters are safe, effective and simple to use. They are a good addition to multimodal analgesia in patients undergoing elective colorectal laparotomy. They are equally effective in patients undergoing emergency laparotomy, however are considerably under-used - an area which will be addressed.
Disclosure of interest None Declared.