Development and evaluation of combined rectus sheath and ilioinguinal blocks for abdominal gynaecological surgery

We describe the development of a technique of combined rectus sheath and ilioinguinal blocks for patients undergoing abdominal gynaecological surgery, and its use in a series of 37 patients (21 midline and 16 transverse incisions). Up to 60 ml of bupivacaine 0.25% with adrenaline 1:400,000 was used, depending on the patient's weight. Median (interquartile range) total morphine requirement (including 0.15 mg x kg(-1) given intra-operatively) up to 48 h after surgery was 0.34 (0.2-0.38) [corrected] mg x kg(-1) for midline incisions and 0.47 (0.35-0.64) [corrected] mg x kg(-1) for transverse incisions; no other systemic opioids were given. Six-hourly pain scores within the first 48 h after surgery were < or =1 (mild pain) in 11 out of 21 (52%) and < or =2 (moderate pain) in 18 out of 21 (86%) patients with midline incisions and in 5 out of 16 (31%) and 13 out of 16 (81%) patients with transverse incisions, respectively. No patient had emetic symptoms worse than mild nausea during the 48-h postoperative study period.