Ultrasound-guided peripheral abdominal wall blocks

Fernandes, Hermann dos Santos; Azevedo, Artur Salgado de; Ferreira, Thiago Castro; Santos, Shirley Andrade; Rocha-Filho, Joel Avancini; Vieira, Joaquim Edson

doi:10.6061/clinics/2021/e2170

Cited by 14 publications

(12 citation statements)

References 41 publications

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“…After local anesthetic infiltration, a 20-gauge needle was inserted in-plane until its tip positioned in the plane between the lateral side of rectus abdominis muscle and the posterior rectus sheath. After negative pressure aspiration, 20 ml bupivacaine 0.25% was injected on each side between rectus abdominis muscle and the posterior rectus sheath [11] . Primary outcome was postoperative pain in first 24 hours.…”

Section: Ultrasound-guided Rectus Sheath Block Techniquementioning

confidence: 99%

Analgesic efficacy of erector spinae plane block versus rectus sheath block in adults undergoing open para-umbilical hernia repair

Hussein

Sadek

Abu-Elyazed

et al. 2022

ijhs

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Background: Rectus sheath block (RSB) is a popular technique for post-operative analgesia for patients undergoing abdominal surgeries with midline incisions. Ultrasound-guided erector spinae plane block (ESPB) is an interfacial plane block for the treatment of post-operative neuropathic pain. The aim of this study was to compare the analgesic efficacy of ESPB versus RSB in adult patients undergoing open para-umbilical hernia repair. Methods: This prospective randomized double-blinded study was carried out on seventy-four adult patients with ASA physical status I-II undergoing open paraumbilical hernia repair. Patients were divided into two equal groups: group I (ESPB): patients received bilateral ultrasound-guided ESPB using bupivacaine 0.25% (20 ml) on each side and group II (RSB): patients received bilateral ultrasound-guided RSB using bupivacaine 0.25% (20 ml) on each side. The following measurements was recorded: VAS score, intraoperative fentanyl consumption, the time to the first postoperative rescue analgesia administration, total dose of postoperative rescue analgesia (morphine) consumption, heart rate and mean arterial blood pressure.

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Section: Ultrasound-guided Rectus Sheath Block Techniquementioning

confidence: 99%

Analgesic efficacy of erector spinae plane block versus rectus sheath block in adults undergoing open para-umbilical hernia repair

Hussein

Sadek

Abu-Elyazed

et al. 2022

ijhs

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“…The authors argue that, since the posterior sheath ends at the arcuate line, there is no target plane in which local anesthetic can spread to cover this kind of incision. Additionally, there are limited studies demonstrating the optimal volume or dose of local anesthetic for this block [4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…There are limited published studies discussing local anesthetic dosing for ultrasound-guided rectus sheath blocks. Volumes utilized range widely from 10 to 30 mL of local anesthetic per side in adults [4][5][6][7][8][9][10][11] and 0.1-0.5 mL/kg in pediatric populations [12][13][14]. Cornish et al described a volume of 20 mL for surgically placed catheters but no rationale was provided for this choice [4].…”

Section: Introductionmentioning

confidence: 99%

Evaluating Patterns of Injectate Spread After Rectus Sheath Block: A Cadaveric Dissection Study

Rojas¹,

McMillan²,

Allan³

et al. 2023

Cureus

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Introduction: This cadaveric dye study assesses the effect of volume and number of injections on the spread of solution after ultrasound-guided rectus sheath injections. In addition, this study evaluates the impact of the arcuate line on solution spread.Materials and methods: Ultrasound-guided rectus sheath injections were performed on seven cadavers on both sides of the abdomen, for a total of 14 injections. Three cadavers received one injection of 30 mL of a solution consisting of bupivacaine and methylene blue at the level of the umbilicus. Four cadavers received two injections of 15 mL of the same solution, one midway between the xiphoid process and umbilicus and one midway between the umbilicus and pubis.Results: Six cadavers were successfully dissected and analyzed for a total of 12 injections, while one cadaver was excluded due to poor tissue quality that was inadequate for dissection and analysis. There was a significant spread of solution with all injections caudally to the pubis without limitation by the arcuate line. However, a single 30 mL injection showed inconsistent spread to the subcostal margin in four of six injections, including in a cadaver with an ostomy. A double injection of 15 mL showed consistent spread from xiphoid to pubis in five of six injections, except in a cadaver with a hernia.Conclusions: Injections deep to the rectus abdominis muscle, using the same technique as an ultrasoundguided rectus sheath block, achieve spread along a large and continuous fascial plane without limitation by the arcuate line and may provide coverage of the entire anterior abdomen. A large volume is necessary for complete coverage and spread is improved with multiple injections. We suggest that two injections with a total volume of at least 30 mL per side may be needed to achieve adequate coverage in the absence of preexisting abdominal abnormalities.

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“…The analgesic effectiveness of ultrasound-guided regional anesthesia for abdominal surgeries is supported by an increasing body of evidence. 1 Regional blocks prove to be valuable and feasible tools for surgical patients, particularly in cases where neuraxial analgesia techniques cannot be performed due to certain reasons, such as coagulopathy, hypovolemia, and neurological disease. Quadratus lumborum block (QLB) is a novel regional block technique that was first reported in 2007.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Posterior Quadratus Lumborum Block for Acute Postoperative Analgesia in Adult Patients: A Meta-Analysis of Randomized Controlled Trials

Lin¹,

Wang²,

Qin³

et al. 2022

TCRM

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Objective The quadratus lumborum block provides postoperative analgesia for patients undergoing abdominal surgery, although there are three common approaches to perform this block. The present meta-analysis investigated the effectiveness of posterior quadratus lumborum block (QLB2) after surgery. Methods PubMed, Embase, and the Cochrane Central Register were searched from inception to 26 August 2021 for randomized controlled trials that evaluated the analgesic efficacy of QLB2 vs control (placebo or no block). The primary outcomes were pain scores at 6 h, 12 h, and 24 h after surgery. The secondary outcomes were morphine consumption at 24 h after surgery and the postoperative complications. Results The present meta-analysis included 14 studies conducted with a total of 1001 patients. In comparison to control group, the QLB2 group presented significantly lower rest pain scores at 6 h (SMD −0.59; 95% CI: −1.05, −0.12; p = 0.01, I 2 = 84%; GRADE = moderate), 12 h (SMD: –0.83; 95% CI: –1.47, –0.19; p = 0.01; I 2 = 88%; GRADE = low), and 24 h (SMD: –0.37; 95% CI: –0.71, –0.03; p = 0.03; I 2 = 80%; GRADE = moderate) after surgery. The dynamic pain scores were significantly reduced, compared to control, in the QLB2 group at 12 h (SMD: –0.93; 95% CI: –1.52, –0.33; p = 0.002; I 2 = 83%; GRADE = low) and 24 h (SMD: –0.52; 95% CI: –0.93, –0.11; p = 0.01; I 2 = 83%; GRADE = moderate) after surgery. In addition, the QLB2 group presented reduced postoperative opioid consumption at 24 h (SMD: –0.45; 95% CI: –0.86, –0.03; p = 0.03; I 2 = 78%; GRADE = moderate). The subgroup analyses revealed that the analgesic benefit of QLB2 did not persist beyond 24 h when the patients were under spinal anesthesia. Conclusion Ultrasound-guided QLB2 could provide effective analgesia for patients under general anesthesia by decreasing the intensity of pain and opioid requirement when used within 24 h after abdominal surgery.

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Ultrasound-guided peripheral abdominal wall blocks

Cited by 14 publications

References 41 publications

Analgesic efficacy of erector spinae plane block versus rectus sheath block in adults undergoing open para-umbilical hernia repair

Analgesic efficacy of erector spinae plane block versus rectus sheath block in adults undergoing open para-umbilical hernia repair

Evaluating Patterns of Injectate Spread After Rectus Sheath Block: A Cadaveric Dissection Study

Ultrasound-Guided Posterior Quadratus Lumborum Block for Acute Postoperative Analgesia in Adult Patients: A Meta-Analysis of Randomized Controlled Trials

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