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Bilateral rectus sheath blocks as the single anaesthetic technique for an open infraumbilical hernia repair
Kelvin How Yow Quek1, Darren Shing Kuan Phua
1Department of Anaesthesia, Changi General Hospital, 2 Simei Street 3, Singapore 529889. kelvin_quek@cgh.com.sg.
Insights
Ultrasonography-guided rectus sheath blocks enabled successful open surgical repair of an infraumbilical hernia in a high-risk patient. This regional anesthesia technique provided adequate analgesia, avoiding general anesthesia and central neuraxial blockade.
Area of Science:
- Regional Anesthesia
- Surgical Case Report
- Abdominal Surgery
Background:
- High-risk patients present challenges for infraumbilical hernia repair.
- General anesthesia and central neuraxial blockade carry significant risks for these patients.
Observation:
- A 45-year-old male with American Society of Anesthesiologists class 4 status, obesity (BMI 34.2 kg/m2), and non-ischemic cardiomyopathy underwent open infraumbilical hernia repair.
- Ultrasonography-guided bilateral rectus sheath blocks were administered using lignocaine and bupivacaine.
Findings:
- The patient tolerated the procedure with minimal additional sedation and analgesia.
- Rectus sheath block proved effective for periumbilical surgery in this high-risk individual.
- Real-time ultrasonographic guidance potentially enhances safety by minimizing risks like peritoneal puncture and visceral injury.
Implications:
- Rectus sheath block is a viable regional anesthesia alternative for high-risk patients undergoing periumbilical surgery.
- Ultrasonography enhances the safety and efficacy of rectus sheath blocks.
- This technique allows for surgical intervention while avoiding the complications associated with general or central neuraxial anesthesia.
Abstract:
We present a case of an open surgical repair of an infraumbilical hernia, which was performed on a 45-year-old man categorised as American Society of Anesthesiologists class 4; he weighed 107 kg, and had a body mass index of 34.2 kg/m2 and nonischaemic cardiomyopathy (left ventricular ejection fraction of 20%). Due to the patient's significant perioperative risks, the surgery was performed with the patient under ultrasonography-guided bilateral rectus sheath blocks; 15 mL of 1% lignocaine and 10 mL of 0.5% bupivacaine were deposited in the space between the rectus abdominis and posterior rectus sheath. The patient tolerated the surgery with minimal further sedation and additional analgesia. Rectus sheath block is a useful regional technique for periumbilical surgery, allowing surgery in highrisk patients while avoiding general anaesthesia and central neuraxial blockade. The use of real-time ultrasonographic guidance may reduce risks of peritoneal puncture, bleeding and visceral injury, while potentially increasing the rate of success.
