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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.

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|February 27, 2023
PubMed
Summary

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 dissectionchronic and acute pain managementrectus sheath blockregional anesthesia and chronic painultra 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.