Ultrasound‐guided rectus sheath blocks for open pyloromyotomy: a chance to turn down the gas

Bailie, Keith; Cullen, Aidan; Eggleton, Andrew

doi:10.1111/pan.12349

Cited by 5 publications

(5 citation statements)

References 3 publications

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“…190,191 It provides similar postoperative analgesia compared with surgical wound infiltration, 192 but more importantly, if administered prior to surgical incision, it allows sparing of intraoperative opioid and volatile anesthetic. This in turn minimizes the concerns of postoperative apnea and adverse effects on neurological development, respectively.…”

Section: Clinical Efficacy Of the Rectus Sheath Blockmentioning

confidence: 99%

Essentials of Our Current Understanding

Chin

McDonnell

Carvalho

et al. 2017

Regional Anesthesia and Pain Medicine

347

208

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Abdominal wall blocks rely on the spread of local anesthetic within musculofascial planes to anesthetize multiple small nerves or plexuses, rather than targeting specific nerve structures. Ultrasonography is primarily responsible for the widespread adoption of techniques including transversus abdominis plane and rectus sheath blocks, as well as the introduction of novel techniques such as quadratus lumborum and transversalis fascia blocks. These blocks are technically straightforward and relatively safe and reduce pain and opioid requirements in many clinical settings. The data supporting these outcomes, however, can be inconsistent because of heterogeneity of study design. The extent of sensory blockade is also somewhat variable, because it depends on the achieved spread of local anesthetic and the anatomical course of the nerves being targeted. The blocks mainly provide somatic analgesia and are best used as part of a multimodal analgesic regimen. This review summarizes the anatomical, sonographic, and technical aspects of the abdominal wall blocks in current use, examining the current evidence for the efficacy and safety of each.

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Section: Clinical Efficacy Of the Rectus Sheath Blockmentioning

confidence: 99%

Essentials of Our Current Understanding

Chin

McDonnell

Carvalho

et al. 2017

Regional Anesthesia and Pain Medicine

347

208

View full text Add to dashboard Cite

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“…There is no evidence that a regional technique is more effective than local infiltration but it has been suggested that bilateral rectus sheath blocks reduce the intraoperative end-tidal vapour concentration required to maintain adequate anaesthesia during open pyloromyotomy. 20 Paracetamol is the only systemic analgesic required. I.V.…”

Section: Gastric Ultrasoundmentioning

confidence: 99%

Anaesthesia for pyloromyotomy

Craig

Deeley

2018

BJA Education

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By reading this article you should be able to:Describe the electrolyte and acid-base abnormalities associated with infantile hypertrophic pyloric stenosis. Explain why these electrolyte and acid-base abnormalities need to be corrected before surgery. Describe the technique for ultrasound examination of the gastric antrum and qualitative assessment of stomach contents before induction of anaesthesia for pyloromyotomy. Discuss the options for induction of anaesthesia including choice of drugs and techniques.Pyloric stenosis is the result of hypertrophy of the smooth muscle of the pylorus, which forms the gastric outlet. Its aetiology is uncertain, although a number of environmental and hereditary contributory factors have been identified. The reported incidence varies between 0.9 and 5.1 per 1000 live births. 1 In England and Wales it is 1.5 per 1000 live births and has remained static in recent years. 2 The risk of the disease is four to five times higher in boys than girls. 3 There is a decline in risk with increasing birth order with an odds ratio of 1.9 for first-born children. 3 The genetic element is evidenced with higher rates of concordance in monozygotic than dizygotic twins and a number of susceptibility loci have been identified.Babies with infantile hypertrophic pyloric stenosis present most commonly in the 2nd and 3rd months of life. 2 However, a recent review of surgical outcomes for 9686 infants who underwent pyloromyotomy in England over a 10-year period, found that 30% of patients were aged 7e28 days at the time of surgery. 2 The classic presentation is projectile vomiting of non-bilious stomach contents, loss of weight or failure to gain weight (crossing centiles on the growth chart), and dehydration. Abdominal examination may reveal a palpable 'olive'; however, modern developments mean that the majority of patients are being diagnosed earlier with ultrasound and this physical finding is becoming less common. Pathophysiology and electrolyte changesVomiting is the principal symptom of pyloric stenosis, classically described as being projectile in nature. The vomitus in pyloric stenosis consists of gastric secretions. These secretions are high in hydrogen and chloride ions with some sodium and potassium, all of which are lost along with water. The electrolyte losses result in a hypokalaemic, hypochloraemic metabolic alkalosis. The water loss causes dehydration and a reduction in plasma volume; this results in the secretion of aldosterone. Aldosterone causes sodium and water retention Key pointsVomiting results in hypochloraemic, hypokalaemic metabolic alkalosis and dehydration; these must be corrected before general anaesthesia and surgery. The stomach should be emptied using a nasogastric or orogastric tube before induction of anaesthesia. Ultrasound can be used to identify fluid in the gastric antrum. Ensuring adequate depth of anaesthesia with complete neuromuscular block before laryngoscopy minimises the risk of regurgitation and pulmonary aspiration. Options for analgesia include rectus sheath ...

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“…RSB can be performed in surgeries with a midline abdominal wall incision including umbilical hernia repair 2,4,8,9 , pyloromyotomy [10][11][12] , laparoscopic surgery [13][14][15] , and major abdominal surgery 16 to provide an effective postoperative analgesia. Several studies comparing the RSB with local anesthetic infiltration proposed that RSB has some significant advantages over local anesthetic infiltration for postoperative pain reduction 3,4,17,18 .…”

Section: Discussionmentioning

confidence: 99%

İnguinal herni cerrahisi geçiren çocuklarda ultrason kılavuzluğunda uygulanan rektus kılıf bloğu ile intravenöz tramadol'ün postoperatif ağrı üzerindeki etkilerinin karşılaştırılması

Güleç¹,

Türktan²,

Hatipoğlu³

et al. 2017

Cukurova Medical Journal (Çukurova Üniversitesi Tıp Fakültesi Dergisi)

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Öz Purpose: Rectus sheath block is a regional anesthesia technique for postoperative pain control. We aimed to evaluate the effects of ultrasound-guided rectus sheath block on postoperative pain relief comparing with intravenous tramadol in children undergoing open inguinal hernia repair. Material and Methods: Forty children, aged between 2-7 years, scheduled for inguinal hernia repair were enrolled into this prospective assessor blinded randomized study. Patients were allocated into one of two groups to receive ultrasound-guided rectus sheath block with a dose of 0.2 ml/kg, levobupivacaine 0.25% (group UR, n=20) or tramadol IV of 1 mg/kg (group T, n=20) under general anesthesia. The primary endpoint was the postoperative pain degree. Postoperative pain scores, sedation levels, supplemental analgesic requirements, and side effects were recorded. Results: Pain scores were lower in group UR compared to group T at postoperative 5 min (UR 1.90 [95% confidence interval [CI], 1.05-2.74] vs T 5.50 [95% CI, 4.31-6.68; P < 0.001]), 15 min (UR 1.00 [95% CI, 0.27-1.72] vs T 4.65 [95% CI, 3.56-5.73; P < 0.001]), 30 min (UR 0.85 [95% CI, 0.08-1.61] vs T 3.05 [95% CI, 2.14-3.95; P < 0.001]) and 60 min (UR 0.20 [95% CI,-0.12-0.52] vs T 0.95 [95% CI, 0.41-1.48; P=0.008]). Fifteen patients required supplemental analgesic in group T whereas group UR patients did not require it. Conclusion: Ultrasound-guided rectus sheath block produces an effective postoperative pain relief in children undergoing inguinal hernia repair surgery, noticeably for the first postoperative hour, compared with tramadol.

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Ultrasound‐guided rectus sheath blocks for open pyloromyotomy: a chance to turn down the gas

Cited by 5 publications

References 3 publications

Essentials of Our Current Understanding

Essentials of Our Current Understanding

Anaesthesia for pyloromyotomy

İnguinal herni cerrahisi geçiren çocuklarda ultrason kılavuzluğunda uygulanan rektus kılıf bloğu ile intravenöz tramadol'ün postoperatif ağrı üzerindeki etkilerinin karşılaştırılması

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