Rectus Sheath block

[Sonny Crocket]

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Anyone do these for umbilical hernia repair? I know that you are supposed to inject into the posterior fascia of the rectus abdominus. But it is a bit scary going that deep with the bowel right underneath.

 

[Planktonmd]

Anyone do these for umbilical hernia repair? I know that you are supposed to inject into the posterior fascia of the rectus abdominus. But it is a bit scary going that deep with the bowel right underneath.

Its a very easy block to do even in very obese patients, it just does not last as long as a TAP block.

 

[Sonny Crocket]

Its a very easy block to do even in very obese patients, it just does not last as long as a TAP block.

Do you that TAP works just as well for umbilical hernias compares with rectus sheath?

 

[dhb]

I do them, works well.
It's 3-4cm deep in my patients usually

 

[BLADEMDA]

Tap blocks work well for umbilical hernia repairs. I prefer a 4 quadrant technique to make sure there is analgesia above the umbilicus.

Rectus Sheath blocks which are single shot only last 6 hours. I don’t think single shot Rectus Sheath blocks are worth the trouble.

 

[ethilo]

Anyone do these for umbilical hernia repair? I know that you are supposed to inject into the posterior fascia of the rectus abdominus. But it is a bit scary going that deep with the bowel right underneath.

The trick is to enter the skin a good distance away from your US probe with a long needle, this way your angle of entry is shallow and you easily slide your way into the space deep to the rectus without going too deep.

 

[ryanjmy]

But it is a bit scary going that deep with the bowel right underneath.

I've never heard of a bowel perf from an abdominal plane block. Not sure if there are any case reports. It's a 22 GA needle. Be careful but not scared.

 

[Planktonmd]

Rectus sheath block works for midline incisions but it does not last, it allows you to give less opiates intra-op if you do it pre-op though.

 

[GassYous]

Surgeons purposefully place needles in the abdomen all the time for insufflation.