Rectus sheath catheters and local anaesthetic - when to monitor vital signs

[coldfish75]

Hi, (I hope I have the right forum here, there are so many to choose from and I'm new to posting)

I'm a year 2 student and have just finished placement on a surgical ward. I had a patient who had abdominal surgery and two rectus sheath catheters which had q4h top-ups of local anaesthetic (LA). When we did the top-up we monitored vital signs right before delivery, and then about 10-15 min after delivery.

Does anyone know why vital signs are monitored before and after LA? I have looked on google and seen articles saying about regular monitoring, but none saying specifically to only monitor signs 15 mins only the once after.

I know that opioids can depress the respiratory system, but does LA via a catheter have the same affect?

I can't remember the name of the anaesthetic being injected, it may have been Marcain, and when I asked the nurse I was working about what change we might see with the vital signs she said that heart rate may go up, and asked me if I knew why, to which I said 'the effects of adrenalin (epinephrine)' to which she said yes that's right.

My placement has finished now so I don't have access to the patient's notes or to the nurse to ask more detail, but I've been thinking more about it. Is it normal to use LA with adrenalin postsurgery? I can understand the LA with adrenalin during surgery to prevent bleeding, but post-surgery back on the ward is it still necessary to cause vasoconstriction? If the LA used had adrenalin then I can understand the HR going up etc, but most articles I've seen talk about respiratory depression and hypotension (but then the articles are mostly talking about epidural and not rectus sheath catheters).

What type of LA is most often used in post-abdominal surgery? How often do you monitor vital signs? Can you direct me to any good texts that explain the reasoning, or do you just go by your own hospital policies?

Thanks in advance,

Debbie

[Skip219, BSN, RN]

Hi,

I believe the rectus catheters are topped off with bupivicaine with epi to decrase tissue uptake and prolong the effect of the LA near the surgical area. Potentially, the migration of anesthetic catheter intravascular could cause hypotension. this complication would warrant baseline and postinjection BPs. I suggest lit search like pubmed for postop rectus catheters for pain management.

Hope this helps,

Skip