A Unique Case Report of Bilateral Rectus Sheath Block as a Sole Anaesthetic Technique for Umbilical Hernia Repair
International Journal of Anesthesia and Clinical Medicine
Volume 8, Issue 2, December 2020, Pages: 65-67
Received: Sep. 16, 2020;
Accepted: Sep. 28, 2020;
Published: Oct. 21, 2020
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Harshal Wagh, Department of Anaesthesia, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
Milin Shah, Department of Anaesthesia, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
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Background: Rectus sheath block has been traditionally used to provide analgesia for anterior abdominal wall surgeries, as it spares the visceral pain component. It’s been used efficiently for intraoperative, post-operative analgesia, providing stable hemodynamic. The emergence of ultrasound has potentially increased the rate of success, while avoiding complications like bleeding, peritoneal puncture, visceral injury. Objective: The author successfully used bilateral rectus sheath block for anesthesia of umbilical hernia repair about which very sparsely is described in literature. The use of ultrasound has increased the accuracy while decreasing the rate of complications. Also complications associated with general anesthesia and central neruaxial block can be avoided. Method: Obstructed umbilical hernia repair and ventral hernia repair were performed under sole ultrasound guided rectus sheath block. 5ml of 2% xylocard and 10ml of 0.75% ropivacaine was deposited on each side between rectus abdominis muscle and posterior rectus sheath. Both were high risk cases and some length of bowel handling was also involved. Yet the patients were comfortable with minimal supplemental analgesics and did not complain of any pain. Conclusion: Bilateral rectus sheath block can provide adequate anesthesia for abdominal hernia surgeries involving some bowel handling if supplemented by intravenous analgesics in high-risk cases. Thus avoiding general anesthesia and central neuraxial blockade.
Peripheral Nerves Block, Anesthesia and Analgesia, Rectus Sheath Block, Hernia Repair
To cite this article
A Unique Case Report of Bilateral Rectus Sheath Block as a Sole Anaesthetic Technique for Umbilical Hernia Repair, International Journal of Anesthesia and Clinical Medicine.
Vol. 8, No. 2,
2020, pp. 65-67.
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
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Schleich CL. Schmerzlose Operationen. Berlin: Springer; 1899: 240-1.
Sandeman DJ, Dilley AV. Ultrasound-guided rectus sheath block and catheter placement. ANZ Journal of Surgery 2008; 78: 621-3.
Azemati S, Khosravi MB. An assessment of the value of rectus sheath block for postlaparoscopic pain in gynecologic surgery. J Minim Invasive Gynecol. 2005; 12: 12-5.
Crosbie EJ, Massiah NS, Achiampong JY, Dolling S, Slade RJ. The surgical rectus sheath block for post-operative analgesia: a modern approach to an established technique. Eur J Obstet Gynecol Reprod Biol. 2012; 160: 196–200.
Gurnaney HG, Maxwell LG, Kraemer FW, et al. Prospective randomized observer-blinded study comparing the analgesic efficacy of ultrasound-guided rectus sheath block and local anaesthetic infiltration for umbilical hernia repair. Br J Anaesth. 2011; 107: 790–5.
Horlocker, Terese, T.; Vandermeuelen, Erik; Kopp, Sandra, L.; Gogarten et al. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Regional Anesthesia and Pain Medicine. 2018; 44 (3): 2263-309.
J Yarwood and A Berrill. Nerve block of the anterior abdominal wall. Continuing Education in Anaesthesia Critical Care & Pain. 2010; 10 (6): 182-86.
Kelvin How Yow Quek, Dareen Shing Kuan Phua. Bilateral rectus sheath block as the single anaesthetic technique for an open infraumbilical hernia repair. Singapore Medical Journal. 2014; 55 (3): 39-41.
Atkinson R, Rushman G, Lee J. A synopsis of anaesthesia. 10th ed. Bristol: Wright; 1987: 637-40.
Muir J, Ferguson S. The rectus sheath block - well worth remembering. Anaesthesia. 1996; 51: 893–4.
Phua DS, Phoo JW, Koay CK. The ultrasound-guided rectus sheath block as an anaesthetic in adult paraumbilical hernia repair. Anaesth Intensive Care. 2009; 37: 499–500.
Quek KH, Phua DS. Bilateral rectus sheath blocks as the single anaesthetic technique for an open infraumbilical hernia repair. Singapore Med J. 2014; 55 (3): e39-e41. doi: 10.11622/smedj.2014042.
Hariharan U, Baduni N, Singh BP. Bilateral rectus sheath block for single-incision laparoscopic tubal ligation in a cardiac patient. J Anaesthesiol Clin Pharmacol. 2016; 32 (3): 414-415. doi: 10.4103/0970-9185.173396.
López-Herrera-Rodríguez D, Guerrero-Domínguez R, Acosta-Martínez J, Sánchez-Carrillo F. Bloqueo de la vaina de los rectos ecoguiado para reparación de hernia umbilical en un paciente con síndrome de Wolff-Parkinson-White: reporte de un caso. Rev Colomb Anestesiol. 2015; 43: 343–345.
Manassero A, Bossolasco M, Meineri M, Ugues S, Liarou C, Bertolaccini L. Spread patterns and effectiveness for surgery after ultrasound-guided rectus sheath block in adult day-case patients scheduled for umbilical hernia repair. J Anaesthesiol Clin Pharmacol [serial online] 2015 [cited 2020 Sep 27]; 31: 349-53.