Case Report

A 43-year-old man with a history of metastatic testicular cancer underwent elective retroperitoneal lymph node dissection and abdominal mass excision. A midline laparotomy incision was made from the xiphoid process to 2 cm below the umbilicus. The procedure was complicated by a minor aortic injury requiring vascular repair. Prior to extubation, the regional anesthesia team placed bilateral ultrasound-guided rectus sheath catheters using Avanos 2.5 inches ON-Q SilverSoaker multiport catheters (2). Ropivacaine 0.25% (50 mL total) was given on placement, followed by a continuous infusion of bupivacaine 0.125% at 6 mL/hour. 

Postoperatively, he received a multimodal analgesic regimen including scheduled oral (PO) acetaminophen, intravenous (IV) ketorolac, and PO & IV hydromorphone as needed. He had expected numbness over his incision and received additional 6mL boluses of bupivacaine 0.125% bilaterally as needed. Pain was overall well-controlled and patient was able to ambulate, take deep breaths, and cough. He was administered three additional opioid doses (two IV and one PO) from POD 1-3 without further need thereafter. His nerve catheters were discontinued and removed on POD 4. He was discharged home on POD 5.  

Our case illustrates that rectus sheath blocks using multiport catheters can provide effective postoperative analgesia and reduce opioid consumption. Multiport catheters have demonstrated superior analgesia compared with end-hole catheters for continuous peripheral nerve blockade (3-4). Within the rectus sheath plane, multiple fenestrations may enhance local anesthetic diffusion and improve midline coverage. Further investigation is warranted to determine whether longer multiport catheters, potentially extending laterally toward the transversus abdominis plane, could provide more comprehensive abdominal wall analgesia.  

Conclusion