A new neurostimulator guided technique of rectus sheath block: study of feasibility and local anesthetic spread in children

Abstract

Background: Rectus sheath block (RSB) is a valuable regional technique for abdominal wall midline analgesia. It can be used for a variety of surgical procedures such as midline laparotomy, umbilical and paraumbilical hernia repair, and laparoscopic surgery. Not all operating theatres, especially in low income countries, are equipped with ultrasound (US) scanners for carrying out US guided regional blocks. In cases of total absence of objective control, neurostimulator (NS) guided technique of RSB can be useful. The aim of the study was to assess the feasibility of performing NS guided RSB.Methods: US guided RSB with NS was performed on patients in group 1. NS guided RSB was performed on patients in group 2. US scanning of block area and clinical efficacy assessment were performed in group 2. Results:In group 1 in all cases of US guided RSB with NS, needle entry into the rectus abdominis muscle resulted in its contractions and needle contact with the posterior sheath resulted in cessation of these contractions. In group 2 optimal spread of local anesthetic was achieved in 86 cases (74.14%), and suboptimal spread in 30 cases (25.86%) of NS guided RSB. There were no cases of non-optimal local anesthetic spread. In all cases NS guided RSB had high clinical efficacy (there was no motor response to incision and no need for fentanyl administration). Conclusions: Rectus sheath block can be performed under neurostimulator guidance. Neurostimulator guided rectus sheath block results in optimal or suboptimal local anesthetic spread. Clinical efficacy of neurostimulator guided rectus sheath block is high.The trial is registered as ACTRN12618000553279 (http://www.ANZCTR.org.au/ACTRN12618 000553279.aspx).

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

“…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 ]. These clinically effective volumes were also addressed in anatomical studies [ 1 , 4 ].…”

“…Studies addressing the effectiveness of RSB have highlighted that the LA injection should cover the entire surgical incision [1]. Hence, the spread distance in the craniocaudal direction and the factors affecting this spread have gained interest in anatomical studies [1][2][3][4][5][6][7]. However, the spread in the mediolateral direction has also been investigated to increase the effectiveness of the block [3,7].…”

“…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]. The anatomical studies included animal cadavers and adult human cadavers, whereas the clinical studies mostly included adult patients [1,[2][3][4]7,8].…”

“…The anatomical studies included animal cadavers and adult human cadavers, whereas the clinical studies mostly included adult patients [1,[2][3][4]7,8]. The limited clinical studies on the effect of RSB in children included pediatric patients of a large age range, leading to a heterogeneous group in terms of anthropometric measures [1,5,9,[10][11][12]. The optimal LA volume to be used as well as its concentration and dose remain controversial; however, some studies have suggested a volume of 10-30 mL in adults and 0.1-0.5 mL/kg in children [13][14][15].…”

Comparison of rectus sheath block and local anesthetic for analgesia in pediatric umbilical hernia repair: A systematic review and meta-analysis

“…RSB is a technique that provides analgesia to the peritoneum, muscles, and skin of the median anterior abdominal wall incision by injecting local anesthetic between the rectus muscle and the posterior rectus sheath and blocking the nerve that travels between them. [3,4] It was first applied by Schleich in 1899 to relax the anterior abdominal wall in adults, and in 1996, Ferguson et al used it for analgesia in pediatric hernia repair, but its clinical use was limited due to complications during blind puncture. [5] In 2006, Wilschke et al pioneered ultrasound-guided RSB.…”