Rectus sheath catheters provide effective pain management after open surgery while reducing complications and costs compared to thoracic epidural analgesia.

• No significant difference in postoperative pain or opioid use between rectus sheath catheters and epidurals.
• Rectus sheath catheters cut hypotension risk by 60% (risk ratio 0.40) and can save $500 to $6,632 per case.

These findings support rectus sheath catheters as a viable option for efficient pain management, especially in fast-track surgery settings.

• Subgroup analysis shows benefits in urinary retention and mobilization time with rectus sheath catheters in non-visceral surgeries.