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Related Experiment Video

Updated: Aug 8, 2025

Two-Dimensional X-Ray Angiography to Examine Fine Vascular Structure Using a Silicone Rubber Injection Compound

Two-Dimensional X-Ray Angiography to Examine Fine Vascular Structure Using a Silicone Rubber Injection Compound

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Evaluating Patterns of Injectate Spread After Rectus Sheath Block: A Cadaveric Dissection Study.

Andres Rojas¹, Daniel T McMillan¹, Jennifer D Allan¹

¹Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA.

|February 27, 2023

Summary

This summary is machine-generated.

Ultrasound-guided rectus sheath injections require at least 30 mL total volume for adequate anterior abdominal coverage. Multiple injections improve solution spread along fascial planes, unaffected by the arcuate line.

Keywords:

cadaver dissection chronic and acute pain management rectus sheath block regional anesthesia and chronic pain ultra sound guided nerve block

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Area of Science:

Anatomy
Regional Anesthesia
Surgical Techniques

Background:

Rectus sheath blocks are crucial for anterior abdominal wall anesthesia.
Understanding solution spread is key to optimizing block efficacy.
The arcuate line's influence on spread is not fully elucidated.

Purpose of the Study:

To evaluate how injection volume and number affect solution spread in ultrasound-guided rectus sheath injections.
To determine the impact of the arcuate line on the spread of injected solutions.
To optimize techniques for comprehensive anterior abdominal coverage.

Main Methods:

A cadaveric study involving ultrasound-guided rectus sheath injections.
Seven cadavers (14 injections total) were used.
Injections varied in volume (15 mL or 30 mL) and number (one or two per side).

Main Results:

Solution spread caudally to the pubis was consistent and not limited by the arcuate line.
A single 30 mL injection showed inconsistent spread to the subcostal margin.
Two 15 mL injections demonstrated consistent spread from xiphoid to pubis, with exceptions in cases of hernia.

Conclusions:

Ultrasound-guided rectus sheath injections provide extensive fascial plane spread, independent of the arcuate line.
Adequate anterior abdominal coverage necessitates a large volume (≥30 mL per side), ideally administered in multiple injections.
Two injections totaling at least 30 mL per side are recommended for optimal coverage, barring abdominal abnormalities.