Ultrasound Blocks for the Anterior Abdominal Wall

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60 | Ultrasound Blocks for the Anterior Abdominal Wall 6. Rectus Sheath Block Savino Spadaro, Tommaso Mauri The central portion of the anterior abdominal wall is innervated by the anterior branches of the spinal nerve roots from T6 to L1. The nerves enter the rectus abdominal muscle near the midline and lie between it and the posterior sheath (Rozen 2008). The superior and inferior epigastric vessels run longitudinally through the medial portion of the muscle (Figure 13.3). The existence of myofascial intersection points on the anterior border of the rectus muscle limits the spread of a local anesthetic solution. The tendinous intersections of the rectus muscle are not present at the posterior rectus sheath, which allows local anesthetic to spread cephalic-caudally within the ipsilateral compartment from a single injection site (Figure 6.1, 6.2). The RSB has been used to provide surgical anesthesia as well as postoperative analgesia for laparotomy or laparoscopic procedures involving the abdominal midline (Finnerty 2010). The block appears to be safe and easy to learn and perform. It provides the anesthesiologist with another method of effective and apparently long-lasting analgesia for common day-case procedures. The RSB should be performed bilaterally with relatively large volumes of local anesthetic.
6. Rectus Sheath Block | 61 Figure 6.1 – Rectus sheath under ultrasound guidance. Figure 6.2 – Rectus abdominal muscle (RAM) and the triple musculo-aponeurotic layer. It can be combined with other blocks, such as the IIB, to achieve wider blockade for transverse incisions below the umbilicus (Yentis 2000). However, in these cases TAPB should be considered. The blind technique is performed using “pop” sensations to determine the positioning of the needle’s tip. The needle is inserted bilaterally at 1 to 3 cm from the midline. The posterior
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Zhirajr Mokini Giovanni Vitale Amed
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| 5 Preface Somatic post-surgical p
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| 7 Savino Spadaro Department of Ex
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Page 11 and 12: | 11 Pediatric Considerations......
Page 13 and 14: 1. Anatomy for Anesthesiologists |
Page 25 and 26: 2. Ultrasound and Regional Anesthes
Page 35 and 36: 3. Transverse Abdominal Plexus Bloc
Page 45 and 46: 4. Iliohypogastric and Ilioinguinal
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Page 63 and 64: 6. Rectus Sheath Block | 63 Table 6
Page 65 and 66: 7. Inguinal Hernia Repair Roberto F
Page 67 and 68: 7. Inguinal Hernia Repair | 67 comp
Page 69 and 70: 7. Inguinal Hernia Repair | 69 Ilio
Page 71 and 72: 8. Inguinal Surgery in Children Giu
Page 73 and 74: 8. Inguinal Surgery in Children | 7
Page 75 and 76: 9. Obstetric and Gynecologic Surger
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Page 79 and 80: 10. Other Abdominal Surgery Procedu
Page 81 and 82: 10. Other Abdominal Surgery Procedu
Page 83 and 84: 11. Abdominal Midline Surgery Savin
Page 85 and 86: 12. Local Anesthetics, Pharmacokine
Page 91 and 92: 13. Complications | 91 13. Complica
Page 93 and 94: 13. Complications | 93 Peritoneal a
Page 95 and 96: 13. Complications | 95 Figure 13.2
Page 97 and 98: 14. References | 97 14. References
Page 99 and 100: 14. References | 99 Caetano AM, Fal
Page 101 and 102: 14. References | 101 Fredrickson M,
Page 103 and 104: 14. References | 103 Kark AE, Kurze
Page 105 and 106: 14. References | 105 (3) McDonnell
Page 107 and 108: 14. References | 107 Rankin G, Stok
Page 109 and 110: 14. References | 109 Toivonen J, Pe
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15. Index | 111 15. Index Index abs
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Ultrasound Blocks for the Anterior Abdominal Wall

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