Ultrasound Blocks for the Anterior Abdominal Wall

11. Abdominal Midline Surgery
Savino Spadaro, Tommaso Mauri
11. Abdominal Midline Surgery | 83
The rectus sheath block (RSB) is safe, easy to learn and
perform, and provides the anesthesiologist with another method
for effective and long-lasting analgesia for common day-case
procedures.
The RSB has been described both in adults and in children.
Although regional anesthesia techniques are commonly used for
postoperative pain control in children, there have been few
studies investigating the efficacy of RSB. The technique is
recommended for midline laparoscopy where it provides
effective analgesia. The onset of analgesia is usually evident
within five to ten minutes and provides excellent operative
conditions with muscular relaxation (Smith 1988). In children,
RSB is a simple block that provides intra- and postoperative
analgesia for umbilical, paraumbelical and epigastric hernia
repair. Another potential use of RSB is for analgesia after
pyloromyotomy. In adults, the RSB may be an alternative to
epidural anesthesia for some surgical procedures (Azemati 2005).
The RSB has also been described as particularly useful to
improve postoperative analgesia after midline laparotomy for
umbilical or epigastric hernia repair in high risk patients.
However, a pilot study failed to demonstrate the advantage of
RSB over infiltration for umbilical hernia repair (Isaac 2006).