{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:36:03Z","timestamp":1792787763476,"version":"4.5.0"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Thoracic epidural analgesia (TEA) remains the \u2018gold standard\u2019 for postoperative pain management after major open surgery, but is potentially associated with hypotension, urinary retention, and delayed recovery. Rectus sheath catheters (RSCs) offer a simple regional alternative that avoids sympathetic blockade while maintaining somatic analgesia. The aim of this review was to compare analgesic efficacy, complications, recovery, patient satisfaction, and costs between RSCs and TEA in open surgical procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review was registered with PROSPERO, the international prospective register of systematic reviews (registration number: CRD420251234467). A systematic PubMed search was conducted to identify studies comparing continuous wound infusion via RSCs with TEA in adult patients undergoing open abdominal, pelvic, thoracic, or vascular surgery. RCTs, as well as prospective and retrospective comparative studies, were included. A meta-analysis was performed for randomized trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 31 studies (21 prospective and 10 retrospective) involving 2162 patients were included. RSCs and TEA did not differ significantly with respect to postoperative pain (standardized mean difference \u22120.35 (95% c.i. \u22122.01 to 1.32)) or opioid consumption (standardized mean difference \u22120.32 (95% c.i. \u22121.71 to 1.07)). No differences were observed in recovery of bowel function, urinary retention, time to mobilization, or length of hospital stay. RSCs significantly reduced the risk of hypotension compared with TEA (risk ratio 0.40 (95% c.i. 0.26 to 0.60)) and were associated with lower costs with savings ranging from $500 to $6632 per case. Subgroup analyses suggested less urinary retention and earlier mobilization with RSCs in non-visceral surgery and non-laparotomy incisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>RSCs provide analgesia comparable to TEA with fewer complications, facilitating earlier recovery and potential cost savings. Considering the growing shift toward fast-track surgery, RSCs represent a pragmatic and resource-efficient alternative for postoperative pain management in open surgical procedures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjs\/znag058","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T11:37:37Z","timestamp":1778585857000},"source":"Crossref","is-referenced-by-count":1,"title":["Rectus sheath catheters\n                    <i>versus<\/i>\n                    thoracic epidural analgesia for pain management after open surgery: systematic review and meta-analysis"],"prefix":"10.1093","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4073-5488","authenticated-orcid":false,"given":"Christian D","family":"Fankhauser","sequence":"first","affiliation":[{"name":"Division of Urology, Department of Surgery, Cantonal Hospital of Winterthur , Winterthur ,","place":["Switzerland"]},{"name":"Faculty of Health Sciences and Medicine, University of Lucerne , Lucerne ,","place":["Switzerland"]},{"name":"Clinic for Urology, University Teaching and Research Hospital of the University of Lucerne , Lucerne ,","place":["Switzerland"]},{"name":"Faculty of Medicine, University of Zurich , Zurich ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Breitenstein","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Zurich , Zurich ,","place":["Switzerland"]},{"name":"Department of Surgery, Cantonal Hospital of Winterthur , Winterthur ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Gelpke","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cantonal Hospital of Winterthur , Winterthur ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caveh","family":"Madjdpour","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Zurich , Zurich ,","place":["Switzerland"]},{"name":"Department of Anaesthesiology, Cantonal Hospital of Winterthur , Winterthur ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gesine","family":"Meili","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Cantonal Hospital of Winterthur , Winterthur ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila","family":"Sultan-Beyer","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Cantonal Hospital of Winterthur , Winterthur ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas R","family":"Wyss","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern , Bern ,","place":["Switzerland"]},{"name":"Department of Interventional Radiology and Vascular Surgery, Cantonal Hospital of Winterthur , Winterthur ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8250-4634","authenticated-orcid":false,"given":"Ernest","family":"Kaufmann","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Medicine, University of Lucerne , Lucerne ,","place":["Switzerland"]},{"name":"Clinic for Urology, University Teaching and Research Hospital of the University of Lucerne , Lucerne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"2026061216541425500_znag058-B1","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1001\/jamasurg.2016.4952","article-title":"Enhanced recovery after surgery: a review","volume":"152","author":"Ljungqvist","year":"2017","journal-title":"JAMA Surg"},{"key":"2026061216541425500_znag058-B2","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/01.sla.0000094300.36689.ad","article-title":"The role of epidural anesthesia and analgesia in surgical practice","volume":"238","author":"Moraca","year":"2003","journal-title":"Ann Surg"},{"key":"2026061216541425500_znag058-B3","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1097\/00000539-200012000-00025","article-title":"The analgesic efficacy of patient-controlled ropivacaine instillation after cesarean delivery","volume":"91","author":"Fredman","year":"2000","journal-title":"Anesth Analg"},{"key":"2026061216541425500_znag058-B4","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1097\/01.anes.0000278903.91986.19","article-title":"Continuous preperitoneal infusion of ropivacaine provides effective analgesia and accelerates recovery after colorectal surgery: a randomized, double-blind, placebo-controlled study","volume":"107","author":"Beaussier","year":"2007","journal-title":"Anesthesiology"},{"key":"2026061216541425500_znag058-B5","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026061216541425500_znag058-B6","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s12871-021-01359-w","article-title":"Comparison of transversus abdominis plane catheters with thoracic epidurals for cost and length of stay in open colorectal surgeries: a cohort study","volume":"21","author":"Miller","year":"2021","journal-title":"BMC Anesthesiol"},{"key":"2026061216541425500_znag058-B7","doi-asserted-by":"crossref","first-page":"2100","DOI":"10.1007\/s00268-021-06072-w","article-title":"Effectiveness of pain control of local anaesthetic wound infusion following elective midline laparotomy: a randomized trial","volume":"45","author":"Gathege","year":"2021","journal-title":"World J Surg"},{"key":"2026061216541425500_znag058-B8","doi-asserted-by":"crossref","first-page":"e0229898","DOI":"10.1371\/journal.pone.0229898","article-title":"Continuous wound infiltration versus epidural analgesia for midline abdominal incisions\u2014a randomized-controlled pilot trial (Painless-Pilot trial; DRKS Number: DRKS00008023)","volume":"15","author":"Klotz","year":"2020","journal-title":"PLoS One"},{"key":"2026061216541425500_znag058-B9","first-page":"182","article-title":"Comparison of incisional and epidural analgesia in the treatment of postoperative pain after cesarean section","volume":"83","author":"Meixnerov\u00e1","year":"2018","journal-title":"Ceska Gynekol"},{"key":"2026061216541425500_znag058-B10","doi-asserted-by":"crossref","first-page":"1902","DOI":"10.3748\/wjg.v22.i5.1902","article-title":"Effectiveness and safety of continuous wound infiltration for postoperative pain management after open gastrectomy","volume":"22","author":"Zheng","year":"2016","journal-title":"World J Gastroenterol"},{"key":"2026061216541425500_znag058-B11","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/S2468-1253(16)30012-7","article-title":"Continuous wound infiltration versus epidural analgesia after hepato-pancreato-biliary surgery (POP-UP): a randomised controlled, open-label, non-inferiority trial","volume":"1","author":"Mungroop","year":"2016","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026061216541425500_znag058-B12","first-page":"1296","article-title":"Continuous epidural versus wound infusion plus single morphine bolus as postoperative analgesia in open abdominal aortic aneurysm repair: a randomized non-inferiority trial","volume":"82","author":"Ball","year":"2016","journal-title":"Minerva Anestesiol"},{"key":"2026061216541425500_znag058-B13","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1002\/bjs.9949","article-title":"Randomized clinical trial of perioperative nerve block and continuous local anaesthetic infiltration via wound catheter versus epidural analgesia in open liver resection (LIVER 2 trial)","volume":"102","author":"Hughes","year":"2015","journal-title":"Br J Surg"},{"key":"2026061216541425500_znag058-B14","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1097\/EJA.0000000000000345","article-title":"Comparison of efficacy and safety of lateral-to-medial continuous transversus abdominis plane block with thoracic epidural analgesia in patients undergoing abdominal surgery: a randomised, open-label feasibility study","volume":"32","author":"Ganapathy","year":"2015","journal-title":"Eur J Anaesthesiol"},{"key":"2026061216541425500_znag058-B15","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1111\/pme.12523","article-title":"Intermittent epidural vs continuous wound infusion of ropivacaine for acute and chronic pain control after hysterectomy or myomectomy: a randomized controlled trial","volume":"15","author":"Fassoulaki","year":"2014","journal-title":"Pain Med"},{"key":"2026061216541425500_znag058-B16","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1053\/j.jvca.2012.09.026","article-title":"Local versus epidural anesthesia in fast-track abdominal aortic surgery","volume":"27","author":"Renghi","year":"2013","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2026061216541425500_znag058-B17","doi-asserted-by":"crossref","first-page":"502","DOI":"10.3109\/01443615.2013.790884","article-title":"An evaluation of the effects of a service change from epidurals to rectus sheath catheters on postoperative pain","volume":"33","author":"Finch","year":"2013","journal-title":"J Obstet Gynaecol"},{"key":"2026061216541425500_znag058-B18","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1111\/j.1365-2044.2011.06700.x","article-title":"Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery","volume":"66","author":"Niraj","year":"2011","journal-title":"Anaesthesia"},{"key":"2026061216541425500_znag058-B19","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1111\/bju.16094","article-title":"A randomized controlled trial investigating rectus sheath catheters following radical cystectomy","volume":"132","author":"Chedgy","year":"2023","journal-title":"BJU Int"},{"key":"2026061216541425500_znag058-B20","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1007\/s00423-024-03534-2","article-title":"Spinal analgesia with continuous local wound infusion vs thoracic epidural analgesia after open pancreaticoduodenectomy","volume":"409","author":"Davies","year":"2024","journal-title":"Langenbecks Arch Surg"},{"key":"2026061216541425500_znag058-B21","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1097\/ALN.0b013e3182800d94","article-title":"Epidural versus continuous preperitoneal analgesia during fast-track open colorectal surgery: a randomized controlled trial","volume":"118","author":"Jouve","year":"2013","journal-title":"Anesthesiology"},{"key":"2026061216541425500_znag058-B22","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/SLA.0000000000002988","article-title":"A randomized controlled trial comparing epidural analgesia versus continuous local anesthetic infiltration via abdominal wound catheter in open liver resection","volume":"269","author":"Bell","year":"2019","journal-title":"Ann Surg"},{"key":"2026061216541425500_znag058-B23","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1053\/j.jvca.2013.02.017","article-title":"Epidural versus ON-Q local anesthetic-infiltrating catheter for post-thoracotomy pain control","volume":"27","author":"Gebhardt","year":"2013","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2026061216541425500_znag058-B24","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/S0034-7094(11)70035-6","article-title":"[Postoperative analgesia: comparing continuous epidural catheter infusion of local anesthetic and opioid and continuous wound catheter infusion of local anesthetic]","volume":"61","author":"de Almeida","year":"2011","journal-title":"Rev Bras Anestesiol"},{"key":"2026061216541425500_znag058-B25","doi-asserted-by":"crossref","first-page":"zrac055","DOI":"10.1093\/bjsopen\/zrac055","article-title":"A comparison between thoracic epidural analgesia and rectus sheath catheter analgesia after open midline major abdominal surgery: randomized clinical trial","volume":"6","author":"Krige","year":"2022","journal-title":"BJS Open"},{"key":"2026061216541425500_znag058-B26","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.ijoa.2006.02.003","article-title":"Incisional and epidural analgesia after caesarean delivery: a prospective, placebo-controlled, randomised clinical study","volume":"15","author":"Ranta","year":"2006","journal-title":"Int J Obstet Anesth"},{"key":"2026061216541425500_znag058-B27","doi-asserted-by":"crossref","first-page":"znae296","DOI":"10.1093\/bjs\/znae296","article-title":"Continuous preperitoneal versus thoracic epidural analgesia in open pancreatoduodenectomy: randomized clinical trial","volume":"111","author":"Lee","year":"2024","journal-title":"Br J Surg"},{"key":"2026061216541425500_znag058-B28","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/j.transproceed.2020.02.004","article-title":"Effectiveness and safety of continuous transverse abdominal plane blocks vs epidural analgesia in donor nephroureterectomy","volume":"52","author":"Calixto-Flores","year":"2020","journal-title":"Transplant Proc"},{"key":"2026061216541425500_znag058-B29","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.3390\/medicina61091695","article-title":"Comparison of bilateral rectus sheath block and thoracic epidural analgesia for postoperative pain control after open gastrectomy: a randomized controlled trial","volume":"61","author":"Opincans","year":"2025","journal-title":"Medicina (Kaunas)"},{"key":"2026061216541425500_znag058-B30","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1213\/ANE.0b013e3182368e87","article-title":"Ropivacaine continuous wound infusion versus epidural morphine for postoperative analgesia after cesarean delivery: a randomized controlled trial","volume":"114","author":"O\u2019Neill","year":"2012","journal-title":"Anesth Analg"},{"key":"2026061216541425500_znag058-B31","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.jss.2020.09.005","article-title":"Epidural versus transabdominal wall catheters: a comparative study of outcomes after pancreatic resection","volume":"259","author":"Perrin","year":"2021","journal-title":"J Surg Res"},{"key":"2026061216541425500_znag058-B32","doi-asserted-by":"crossref","first-page":"2287","DOI":"10.1245\/s10434-020-09067-4","article-title":"Surgeon-placed continuous wound infusion pain catheters markedly decrease narcotic use and improve outcomes after pancreatic tumor resection","volume":"28","author":"Kone","year":"2021","journal-title":"Ann Surg Oncol"},{"key":"2026061216541425500_znag058-B33","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/j.amjsurg.2011.05.016","article-title":"A comparison of postoperative outcomes utilizing a continuous preperitoneal infusion versus epidural for midline laparotomy","volume":"202","author":"Gross","year":"2011","journal-title":"Am J Surg"},{"key":"2026061216541425500_znag058-B34","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1111\/anae.16087","article-title":"Patients\u2019 expectations, experience and acceptability of postoperative analgesia: a nested qualitative study within a randomised controlled trial comparing rectus sheath catheter and thoracic epidural analgesia","volume":"78","author":"Brearley","year":"2023","journal-title":"Anaesthesia"},{"key":"2026061216541425500_znag058-B35","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1093\/bja\/aes091","article-title":"Cost-effectiveness analysis comparing epidural, patient-controlled intravenous morphine, and continuous wound infiltration for postoperative pain management after open abdominal surgery","volume":"108","author":"Tilleul","year":"2012","journal-title":"Br J Anaesth"},{"key":"2026061216541425500_znag058-B36","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1093\/bja\/85.1.109","article-title":"The stress response to trauma and surgery","volume":"85","author":"Desborough","year":"2000","journal-title":"Br J Anaesth"},{"key":"2026061216541425500_znag058-B37","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1097\/AOG.0b013e3181f38ac6","article-title":"Improving continuous wound infusion effectiveness for postoperative analgesia after cesarean delivery: a randomized controlled trial","volume":"116","author":"Rackelboom","year":"2010","journal-title":"Obstet Gynecol"},{"key":"2026061216541425500_znag058-B38","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1136\/rapm-00115550-199621030-00002","article-title":"The regional anesthesia \u201clearning curve\u201d. what is the minimum number of epidural and spinal blocks to reach consistency?","volume":"21","author":"Kopacz","year":"1996","journal-title":"Reg Anesth"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjs\/advance-article-pdf\/doi\/10.1093\/bjs\/znag058\/68282135\/znag058.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/113\/6\/znag058\/68282135\/znag058.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/113\/6\/znag058\/68282135\/znag058.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T20:54:22Z","timestamp":1781297662000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/doi\/10.1093\/bjs\/znag058\/8677794"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":38,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,5,13]]},"published-print":{"date-parts":[[2026,6,4]]}},"URL":"https:\/\/doi.org\/10.1093\/bjs\/znag058","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,5,13]]},"article-number":"znag058"}}