Related Experiment Video
Updated: May 4, 2026
Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
Published on: January 31, 2025
Ultrasound-guided rectus sheath block in children with umbilical hernia: Case series
Abdul Hamid Alsaeed1, Ahmed Thallaj1, Nancy Khalil1
1Department of Anesthesia, Pediatric Anaesthesia Division, King Saud University, Riyadh, Saudi Arabia.
Insights
Ultrasound-guided rectus sheath blocks effectively managed postoperative pain in pediatric umbilical hernia repair. This technique provided excellent analgesia with no complications, improving patient recovery.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia
- Surgical Pain Management
Background:
- Umbilical hernia repair in children commonly results in significant postoperative pain.
- Rectus sheath blocks are a preferred alternative to caudal blocks due to fewer side effects.
- Ultrasound guidance enhances the safety and efficacy of peripheral nerve blocks.
Purpose of the Study:
- To evaluate the effectiveness of ultrasound-guided rectus sheath blocks for pain relief in pediatric patients undergoing umbilical hernia repair.
Main Methods:
- Twenty-two children (1.5-8 years) received ultrasound-guided posterior rectus sheath blocks.
- A 5-16 MHz linear probe and an in-plane technique with a 22G needle were used.
- Postoperative pain was assessed using the modified CHEOPS scale.
Main Results:
- Ultrasound visualization of the posterior rectus sheath was successful in all cases.
- The block provided effective analgesia for all patients, with only one requiring additional morphine.
- No complications were reported during or after the procedure.
Conclusions:
- Ultrasound guidance facilitates effective rectus sheath block for pediatric umbilical hernia repair.
- The specific needle used allowed for easy, less traumatic penetration.
- This technique offers a safe and efficient method for postoperative pain control.
Background:
Umbilical hernia repair, a common day-case surgery procedure in children, is associated with a significant postoperative pain. The most popular peripheral nerve blocks used in umbilical hernia repair are rectus sheath infiltration and caudal block. The rectus sheath block may offer improved pain relief following umbilical hernia repair with no undesired effects such as lower limb motor weakness or urinary retention seen with caudal block which might delay discharge from the hospital. Ultrasound guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. The aim of this case series is to assess the post rectus sheath block pain relief in pediatric patients coming for umbilical surgery.
Methods:
Twenty two (22) children (age range: 1.5-8 years) scheduled for umbilical hernia repair were included in the study. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 5-16 MHz 50 mm linear probe. An ultrasound-guided posterior rectus sheath block of both rectus abdominis muscles (RMs) was performed (total of 44 punctures). An in-plain technique using Stimuplex A insulated facet tip needle 22G 50mm. Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia by means of the modified CHEOPS scale were evaluated.
Results:
ultrasonograghic visualization of the posterior sheath was possible in all patients. The ultrasound guided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia except for one patient who postoperatively required morphine 0.1 mg/kg intravenously. There were no complications.
Conclusions:
Ultrasound guidance enables performances of an effective rectus sheath block for umbilical hernia. Use of the Stimuplex A insulated facet tip needle 22G 50mm provides easy, less traumatic skin and rectus muscle penetration and satisfactory needle visualiza.
