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. 2015 Jul-Sep;31(3):349-53.
doi: 10.4103/0970-9185.161671.

Spread patterns and effectiveness for surgery after ultrasound-guided rectus sheath block in adult day-case patients scheduled for umbilical hernia repair

Alberto Manassero  1 , Matteo Bossolasco  1 , Maurizio Meineri  1 , Susanna Ugues  1 , Chrysoula Liarou  1 , Luca Bertolaccini  2
Affiliations

Spread patterns and effectiveness for surgery after ultrasound-guided rectus sheath block in adult day-case patients scheduled for umbilical hernia repair

Alberto Manassero et al. J Anaesthesiol Clin Pharmacol. 2015 Jul-Sep.

Abstract

Background and aims: We conducted a prospective study to examine the local anesthetic (LA) spread and the effectiveness for surgical anesthesia of ultrasound (US)-guided rectus sheath block (RSB) in adult patients undergoing umbilical hernia repair.

Material and methods: Thirty patients received at T-10 level a bilateral US-guided injection of 20 mL levobupivacaine 0.375% + epinephrine 5 μg/mL behind the rectus muscle to detach it from its sheath. Anesthetic spread into the rectus sheath was evaluated ultrasonographically at T-9 and T-11 levels and scored from 0 to 4. The RSB was defined effective for surgical anesthesia if it was able to guarantee an anesthetic level sufficient for surgery without any mepivacaine supplementation.

Results: Overall, the block was effective for surgical anesthesia in 53.3% of patients (95% confidence interval, ±17.8). In the remaining patients, anesthesia supplementation was needed at cutaneous incision, whereas manipulation of the muscle and fascial planes was painless. No patients required general anesthesia. LA spreads as advocated (to T-9 and to T-11 bilaterally = spread score 4) in 8/30 patients (26.6%); in these cases, the block was 75% effective for surgery. The anesthetic spread was most negatively influenced by increased body mass index. Postoperative analgesia was excellent in 97% of patients.

Conclusion: Use of RSB as an anesthetic management of umbilical herniorrhaphy is recommended only with anesthetic supplementation at the incision site.

Keywords: Rectus sheath block; ultrasound-guided; umbilical hernia repair.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Dermatome lines. A-A’ = Linea alba, B-B’= Linea semilunaris, C = Costal margin
Figure 2
Figure 2
Ultrasound visualization of rectus muscle in transversus orientation at the T-10 level. A = Subcutaneous, B = Muscle, C = Bowel, arrow = Posterior rectus sheath and the fascia transversalis
Figure 3
Figure 3
Tuohy needle introduction
Figure 4
Figure 4
Local anesthetic (LA) injection. A = Subcutaneous, B = Muscle rectus, C = Bowel, * = Needle, ° = LA, thin arrow = Rectus sheath and the fascia transversalis, large arrow = Posterior wall of the rectus
See this image and copyright information in PMC

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