Para‐umbilical block: a new concept for regional anaesthesia in children

Abstract

This preliminary study describes a new technique to provide analgesia in children undergoing umbilical hernia repair. The para-umbilical block consists of infiltrating the anterior cutaneous branches of the two tenth spinal roots over and under the rectus sheath far from the operative field. Intra and postoperative analgesia as well as operative conditions were assessed in 11 children 16.7 +/- 31 months old, weighing 8421 +/- 6941 g, the block being performed before surgery under light general anaesthesia. Intraoperative analgesia, operative conditions and recovery were good in all patients. Analgesia was adequate one h after surgery in ten patients, six h after surgery in eight. The block proved to be safe and on the whole effective in this short series. The study should proceed on a multi-centre basis if possible. Indications can be extended.

Rectus sheath block for postoperative pain relief in children undergoing major abdominal surgery

“…It can be explained why some patients had pain and the rectus sheath block failed. Courreges et al [4] described a new technique to provide analgesia in 11 children undergoing the umbilical hernia repair: the para-umbilical block. In this paper, the authors stated that the course of the cutaneous branch of the 10th intercostal nerve is variable.…”

“…Interest in the block has been renewed following reports of its analgesic efficacy in adults undergoing laparoscopy and in children for para-umbilical and umbilical hernia repair [2][3][4]. Studies in adults and children have compared the rectus sheath block with opioids alone for analgesia after laparoscopic surgery, showing favorable results [2,5].…”

“…Two techniques have been described in children [3,4]. Both of these techniques purposed to block the terminal branches of 9th, 10th and 11th intercostal nerve within the rectus sheath in a different way.…”

Bloqueo de fascia de rectos abdominales guiado por ultrasonido. Revisión narrativa

“…Esta rama sensitiva cutánea puede dividirse antes de que el nervio intercostal perfore la fascia de los rectos y trascurrir por encima de la hoja anterior de dicha fascia hasta en un 30 % de las personas [4,11]. Es poco frecuente obtener imágenes sonoanatómicas de los nervios por su variabilidad anatómica y tamaño [2,12].…”

“…Ramas de la arteria epigástrica inferior (que trascurre caudocefálico en el plano entre la hoja posterior de la fascia y el músculo recto abdominal) perforan e irrigan el músculo recto y pueden verse con las aplicaciones Doppler color y Power Doppler [4,11]. La variabilidad anatómica de las arterias epigástricas y sus ramas musculares hacen aconsejable el uso de ultrasonido para su identificación y consecuente disminución de la frecuencia de hematomas asociados al bloqueo [2].…”