Ultrasound-guided para-umbilical block: a pediatric case

Abstract

Background: Rectus sheath block is a common peripheral nerve block for patients undergoing umbilical hernia repair surgery. However, rectus sheath block alone can affect only anterior branches of intercostal nerves and, therefore, is incomplete for postoperative analgesia for the anterior abdomen, which is innervated by both anterior and lateral branches. We describe a successful perioperative analgesia with ultrasound-guided para-umbilical block after pediatric umbilical hernia surgery.

Case presentation: A 4-year-old child underwent hernia repair surgery. Following induction of general anesthesia, the anatomy of the umbilical region was observed under ultrasound with a 5-10-MHz linear probe. An ultrasound-guided injection between the rectus abdominis muscle and the posterior lobe of the rectus sheath and an injection into the subcutaneous space around the umbilicus were performed. The peripheral nerve block was effective during surgery, and the patient required no additional rescue analgesia during the perioperative period. There were no complications.

Conclusion: We performed ultrasound-guided para-umbilical block with four injections. This peripheral nerve block could be an efficient technique for complete perioperative analgesia.

Keywords: Para-umbilical block; Pediatric anesthesia; Perioperative analgesia.

Fig. 1

The injection between the rectus muscle and the posterior sheath. The tip of the needle (yellow arrow) is on the posterior lobe of the rectus sheath. The deposition of injected local anesthetic (blue semicircle) is observed behind the rectus abdominis muscle. RAM rectus abdominis muscle, IOM internal oblique muscle, TAM transversus abdominis muscle

Fig. 2

The injection in the subcutaneous tissue. The tip of the needle (yellow arrow) is in the subcutaneous space around the umbilicus. The depositions of injected local anesthetic (blue) are also observed inside the rectus sheath. RAM rectus abdominis muscle