Single injection ultrasound‐guided rectus sheath blocks for children: Distribution of injected anesthetic

Abstract

Summary Background Single injection ultrasound‐guided rectus sheath blocks are used for postoperative analgesia after midline abdominal incisions, but the ultrasonographic spread of medication posterior to the rectus muscle has not been investigated. Aims The primary goal of this study was to determine the ultrasound‐measured medication spread superiorly and inferiorly after single injection ultrasound‐guided rectus sheath blocks and to calculate the incidence of cases with spread up to the subcostal margin and below of umbilicus. The secondary goals were to correlate the spread with the volume of medication administered and with the patient's age, weight, height, sex, and body mass index. Methods Pediatric patients who underwent single injection ultrasound‐guided rectus sheath blocks and underwent data collection of ultrasonographic information on medication spread along the plane of the posterior rectus sheath were identified retrospectively from an acute pain service database at UPMC Children's Hospital of Pittsburgh. Results Sixty‐eight children, 10.2 ± 4.2 (mean ± SD) years old, 41.7 ± 17.9 kg, 140 ± 24.6 cm, had complete data collection. Mean injected volume of ropivacaine was 8.3 ± 2.8 mL (right) and 8.2 ± 2.8 mL (left). The average spread was measured as 3.9 ± 1.4 cm (right) and 3.4 ± 1.3 cm (left) cranial to the umbilicus, and 1.5 ± 1.6 cm (right) and 1.6 ± 1.4 cm (left) caudal to the umbilicus. Complete spread up to the level of the subcostal margin was observed in 52.9% (n = 36; right) and 36.8% (n = 25; left) of cases. The spread correlated closely with the volume of injected ropivacaine (right: 0.556, P < 0.001; left: 0.541, P < 0.001). The spread below umbilicus was 70.6% (n = 48, right) and 80.9% (n = 55, left). There was a positive strong correlation (P < 0.001) between total medication spread and age (right: 0.608; left: 0.538), weight (right: 0.600; left: 0.540), and height (right: 0.593; left: 0.526). Conclusion After single injection ultrasound‐guided rectus sheath blocks, incomplete cephalocaudal medication spread can be expected within the posterior rectus sheath.

The Spread Distance of Local Anesthetics in the Rectus Sheath Block in Children Aged 0-8 Years: A Retrospective Study

“…The authors reported that the LA reached the subcostal line on the right side in 52.9% of patients and on the left side in 36.8% of patients. Hence, they emphasized that it might be more suitable to change the injection point according to the surgical incision site [ 1 ]. Our study has strengths in certain points.…”

“…Our study has strengths in certain points. The age group of the children in the study by Visoui et al [ 1 ] constituted a heterogeneous group considering the anthropometric differences among children in the 0-18-year range. In our study, the age group was 0-8 years, which could be expected to be a homogeneous group; moreover, the spread distances were also compared between subgroups of ages comprising children aged 0-2 years and 2-8 years to ensure homogeneity.…”

“…The spread pattern of the LA was found to be correlated with the injected volume of the LA solution, as well as the age, body weight, height, and body mass index of the patient [ 1 , 8 ]. Injecting 0.1 mL/kg and 0.5 mL/kg from a single injection point in children has been reported when we consider studies addressing the efficacy of RSB [ 5 , 9 - 12 ].…”

“…The rectus sheath block (RSB) can be used to provide analgesia for anterior abdominal wall surgeries such as umbilical and epigastric hernia repair, laparoscopic surgery, and midline laparotomy procedures. The spread of the local anesthetic (LA) solution in the rectus sheath should cover the entire surgical incision to achieve the optimal effect of the RSB [1]. The factors affecting this spread have been addressed in previous studies including both anatomical and clinical studies [1][2][3][4][5][6].…”

Preoperative Implementation of Transverse Thoracic Muscle Plane Block and Rectus Sheath Block Combination for Pediatric Cardiac Surgery

“…The layer between the rectus abdominis muscle and the posterior layer of the rectus sheath is the target for the RSB. 7,8 Real-Time, Ultrasound-Guided TTP Block Procedure All block procedures are performed in a sterile fashion as follows: the puncture sites are disinfected, the anesthesiologist performing the puncture wears sterile gloves, and the ultrasound probe is covered with a sterile probe cover (Fig 2, A and Fig 3, A).…”