About our project

Emergency Laparotomy (EL) is a surgical procedure used to treat various surgical emergencies affecting abdominal organs and structures. It is a relatively high-risk procedure. The recurring annual National Emergency Laparotomy Audit (NELA) conducted by the Healthcare Quality Information Partnership (HQIP) highlights a 30-day mortality rate of 9.6%. Intensive Care (ICU) or High Dependency unit (HDU) admissions postoperatively are common, with estimated mortality >5% usually prompting referral.

Effective management of postoperative pain is an important factor in reducing risk of morbidity and mortality. Where analgesia is ineffective, patients are at greater risk of postoperative pulmonary complications (PPC), which predispose to worse outcomes.

For major elective abdominal surgery the anaesthetist can usually counsel the patient about different forms of analgesia, which may include epidural, other regional techniques, patient controlled analgesia (PCA), or other modalities. In emergency procedures there is often not time for a full discussion of these options, and indeed there may be contraindications to their use.

Rectus sheath catheters are a relatively simple option for analgesia, whereby small catheters are sited within the rectus sheath, adjacent to the surgical wound. Local anaesthetic is infused through these catheters, leading to reduced pain sensation. Though their use is widespread, their efficacy compared with other analgesic options following emergency laparotomy has not yet been studied in detail. Moreover, there is wide variation in how they are used – in particular whether they are inserted by surgeons or anaesthetists, whether they are inserted prior to or after skin incision, and what drug is infused through them.

A retrospective service evaluation including all adult patients (≥ 18 years old) undergoing emergency laparotomy at each hospital over a two-week period.

Data will be gathered by volunteers using an electronic form, or using paper forms, and then uploaded before being collated centrally.

Results will be communicated to each hospital, with comparisons between their own data and the region overall.

The project will be coordinated by the West Midlands Trainee Research in Anaesthesia and Intensive care Network (WMTRAIN). Senior oversight will be provided by Professor Fang Gao, Professor of Anaesthesia at the University of Birmingham.

Hospitals and regions outside the West Midlands are encouraged to participate.

No comparative statistical analyses are planned. Data will be reported as summary statistics with simple figures only.

This project is not considered ‘research’ by the Health Research Authority’s online decision making tool. Identifiable data will not be recorded, and no generalisable findings will be generated. As such, this project does not require NHS Research Ethics Committee approval. Local governance / audit approvals should be sought at each participating site.

No directly identifiable data will be collected as part of this project. Age shall be categorised into granular deciles rather than being recorded exactly. The central dataset will be encrypted, password protected and access-limited using the REDCap service hosted by the Birmingham Surgical Trials Consortium (BiSTC). Only agreed members of the project team will have access to the overall dataset. Participating sites’ data will not be shared with other sites.