Rectus sheath block: successful use in the chronic pain management of pediatric abdominal wall pain

Abstract

Seven pediatric patients (aged 11-16 years) with chronic abdominal wall pain are presented who gained significant relief from a rectus sheath block (RSB). We describe the case histories and review the relevant literature for this technique. The etiology of the abdominal wall pain was considered to be abdominal cutaneous nerve entrapment, iatrogenic peripheral nerve injury, myofascial pain syndrome or was unknown. All patients showed significant initial improvement in pain and quality of life. Three patients required only the RSB to enable them to be pain-free and return to normal schooling and physical activities. Two children received complete relief for more than 1 year. In the majority of cases, the procedure was carried out under general anesthesia as a daycase procedure. Local anesthetic and steroids were used. This is the first report of the successful use of this technique in the chronic pain management setting in children.

Thoracic Disk Herniation, a not Infrequent Cause of Chronic Abdominal Pain

“…Women are more often affected than men (4:1), with a peak incidence in both sexes between 30 and 50 years of age, although it may also affect children and elders. [9][10][11] The abdominal wall source of pain includes all conditions that involve the structures of the abdominal wall: skin, parietal peritoneum, subcutaneous cell tissue, aponeurosis, abdominal muscle groups, and somatosensory innervations from nerve roots T7 to T12. In the latter case, both the sympathetic visceral fibers and the nociceptive somatic afferent fibers converge in the same thoracic root, 12 therefore the pain arising from the spinal muscles or the vertebral body may be misinterpreted as of visceral origin.…”

Implantation of an intercostal nerve stimulator for chronic abdominal pain

“…5 Similarly, peripheral nerve blockade has been successfully employed in paediatric patients with chronic abdominal wall pain. 6 Nerve stimulators have been employed to guide paravertebral blockade in patients with thoracic myofascial pain syndrome. 7 However, to date, there have been no reports of using an implantable peripheral nerve stimulator to treat chronic abdominal pain successfully.…”

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

“…Studies in adults and children have compared the rectus sheath block with opioids alone for analgesia after laparoscopic surgery, showing favorable results [2,5]. It was successfully used in chronic pain management of pediatric abdominal wall pain [6].…”