Ultrasound Blocks for the Anterior Abdominal Wall
Ultrasound Blocks for the Anterior Abdominal Wall
Ultrasound Blocks for the Anterior Abdominal Wall
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58 | <strong>Ultrasound</strong> <strong>Blocks</strong> <strong>for</strong> <strong>the</strong> <strong>Anterior</strong> <strong>Abdominal</strong> <strong>Wall</strong><br />
Since complete block may not occur, intraoperative<br />
analgo-sedation or local anes<strong>the</strong>tic supplement by <strong>the</strong> surgeon<br />
may be required <strong>for</strong> patient com<strong>for</strong>t. Moreover, subcutaneous<br />
injection along <strong>the</strong> incision line is necessary <strong>for</strong> a good IFB/LIA<br />
because of <strong>the</strong> variability of innervation of <strong>the</strong> IHN and IIN and<br />
<strong>the</strong> heterogeneous afferences from o<strong>the</strong>r nerves.<br />
Figure 5.5 – From left to right: Iliohypogastric and ilioinguinal nerve<br />
block, genitofemoral nerve block and wound infiltration (Triple block).<br />
After ultrasound-guided IIB and gGFB, a 90 mm needle is<br />
entirely advanced in <strong>the</strong> subcutaneous tissue under <strong>the</strong> incision<br />
line. Injection is made while slowly retracting <strong>the</strong> needle and<br />
aspirating from time to time. Depending on <strong>the</strong> patient’s body<br />
mass index, 10 to 30 ml are generally required. This block<br />
provides optimal operative conditions, almost immediate<br />
discharge criteria achievement, low analgesic requirement and<br />
high patient satisfaction. The technique has several advantages
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