ORIGINAL ARTICLE
A new neurostimulator guided technique of rectus sheath block: study of feasibility and local anesthetic spread in children
1
Lviv Regional Children’s Clinic Hospital, Lviv, Ukraine
2
Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
Publication date: 2019-06-16
Anaesthesiol Intensive Ther 2019;51(2):83-87
KEYWORDS
ABSTRACT
Background:
Rectus sheath block (RSB) is a valuable regional technique for abdominal wall midline analgesia. It can be used for a variety of surgical procedures such as midline laparotomy, umbilical and paraumbilical hernia repair, and laparoscopic surgery. Not all operating theatres, especially in low income countries, are equipped with ultrasound (US) scanners for carrying out US guided regional blocks. In cases of total absence of objective control, neurostimulator (NS) guided technique of RSB can be useful. The aim of the study was to assess the feasibility of performing NS guided RSB.
Methods:
US guided RSB with NS was performed on patients in group 1. NS guided RSB was performed on patients in group 2. US scanning of block area and clinical efficacy assessment were performed in group 2.
Results:
In group 1 in all cases of US guided RSB with NS, needle entry into the rectus abdominis muscle resulted in its contractions and needle contact with the posterior sheath resulted in cessation of these contractions. In group 2 optimal spread of local anesthetic was achieved in 86 cases (74.14%), and suboptimal spread in 30 cases (25.86%) of NS guided RSB. There were no cases of non-optimal local anesthetic spread. In all cases NS guided RSB had high clinical efficacy (there was no motor response to incision and no need for fentanyl administration).
Conclusions:
Rectus sheath block can be performed under neurostimulator guidance. Neurostimulator guided rectus sheath block results in optimal or suboptimal local anesthetic spread. Clinical efficacy of neurostimulator guided rectus sheath block is high. The trial is registered as ACTRN12618000553279 (http://www.ANZCTR.org.au/ACTRN12618 000553279.aspx).
Rectus sheath block (RSB) is a valuable regional technique for abdominal wall midline analgesia. It can be used for a variety of surgical procedures such as midline laparotomy, umbilical and paraumbilical hernia repair, and laparoscopic surgery. Not all operating theatres, especially in low income countries, are equipped with ultrasound (US) scanners for carrying out US guided regional blocks. In cases of total absence of objective control, neurostimulator (NS) guided technique of RSB can be useful. The aim of the study was to assess the feasibility of performing NS guided RSB.
Methods:
US guided RSB with NS was performed on patients in group 1. NS guided RSB was performed on patients in group 2. US scanning of block area and clinical efficacy assessment were performed in group 2.
Results:
In group 1 in all cases of US guided RSB with NS, needle entry into the rectus abdominis muscle resulted in its contractions and needle contact with the posterior sheath resulted in cessation of these contractions. In group 2 optimal spread of local anesthetic was achieved in 86 cases (74.14%), and suboptimal spread in 30 cases (25.86%) of NS guided RSB. There were no cases of non-optimal local anesthetic spread. In all cases NS guided RSB had high clinical efficacy (there was no motor response to incision and no need for fentanyl administration).
Conclusions:
Rectus sheath block can be performed under neurostimulator guidance. Neurostimulator guided rectus sheath block results in optimal or suboptimal local anesthetic spread. Clinical efficacy of neurostimulator guided rectus sheath block is high. The trial is registered as ACTRN12618000553279 (http://www.ANZCTR.org.au/ACTRN12618 000553279.aspx).
REFERENCES (19)
1.
Schultz-Machata AM, Weiss M, Becke K. What’s new in pediatric acute pain therapy? Curr Opin Anaesthesiol 2014; 27: 316-322. doi: 10.1097/ACO.0000000000000074.
2.
Eroglu A, Erturk E, Apan A, Apan OC. Regional anesthesia for postoperative pain control. Biomed Res Int 2014; 2014: 309606. doi: 10.1155/2014/309606.
3.
Ecoffey C, Lacroix F, Giaufré E, Orliaguet G, Courrèges P; Association des Anesthésistes Réanimateurs Pédiatriques d’Expression Française (ADARPEF). Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Paediatr Anaesth 2010; 20: 1061-1069. doi: 10.1111/j.1460-9592.2010.03448.x.
4.
Muir J, Ferguson S. The rectus sheath block-well worth remembering. Anaesthesia 1996; 51: 893-894.
5.
Ferguson S, Thomas V, Lewis I. The rectus sheath block in paediatric anaesthesia: new indications for an old technique? Paediatr Anaesth 1996; 6: 463-466.
6.
Finnerty O, Carney J, McDonnell JG. Trunk blocks for abdominal surgery. Anaesthesia 2010; 65 Suppl 1: 76-83. doi: 10.1111/j.1365-2044. 2009.06203.x.
7.
Erdmann AG. Concise Anatomy for Anaesthesia. Greenwich Medical Media, London 2002; p. 143.
8.
Abrahams MS, Horn JL, Noles LM, Aziz MF. Evidence-based medicine: ultrasound guidance for truncal blocks. Reg Anesth Pain Med 2010; 35 (2 Suppl): S36-42. doi: 10.1097/AAP.0b013e3181d32841.
9.
Quek KH, Phua DS. Bilateral rectus sheath blocks as the single anaesthetic technique for an open infraumbilical hernia repair. Singapore Med J 2014; 55: e39-41. doi: 10.11622/smedj.2014042.
10.
Bashandy GM, Elkholy AH. Reducing postoperative opioid consumption by adding an ultrasound-guided rectus sheath block to multimodal analgesia for abdominal cancer surgery with midline incision. Anesth Pain Med 2014; 4: e18263. doi: 10.5812/aapm.18263.
11.
Takebayashi K, Matsumura M, Kawai Y, et al. Efficacy of transversus abdominis plane block and rectus sheath block in laparoscopic inguinal hernia surgery. Int Surg 2015; 100: 666-671. doi: 10.9738/INTSURG-D-14-00193.1.
12.
Bakshi S, Mapari A, Paliwal R. Ultrasound-guided rectus sheath catheters: A feasible and effective, opioid-sparing, post-operative pain management technique: a case series. Indian J Anaesth 2015; 59: 118-120. doi: 10.4103/0019-5049.151376.
13.
Singh SK, Kuruba SMG. The Loss of Resistance Nerve Blocks. ISRN Anesthesiology 2011; 2011: 10. Article ID 421505, doi: 10.5402/ 2011/421505.
14.
Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth 2005; 94: 7-17.
15.
Skinner AV, Lauder GR. Rectus sheath block: successful use in the chronic pain management of pediatric abdominal wall pain. Paediatr Anaesth 2007; 17: 1203-1211.
16.
Willschke H, Bösenberg A, Marhofer P, et al. Ultrasonography-guided rectus sheath block in paediatric anaesthesia – a new approach to an old technique. Br J Anaesth 2006; 97: 244-249.
17.
Manassero A, Bossolasco M, Meineri M, Ugues S, Liarou C, Bertolaccini L. Spread patterns and effectiveness for surgery after ultrasound-guided rectus sheath block in adult day-case patients scheduled for umbilical hernia repair. J Anaesthesiol Clin Pharmacol 2015; 31: 349-353. doi: 10.4103/0970-9185.161671.
18.
Neal JM, Brull R, Horn JL, et al. The Second American Society of Regional Anesthesia and Pain Medicine Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia: Executive Summary. Reg Anesth Pain Med 2016; 41: 181-194. doi: 10.1097/AAP. 0000000000000331.
19.
Polaner DM, Taenzer AH, Walker BJ, et al. Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesth Analg 2012; 115: 1353-1364. doi: 10.1213/ANE.0b013e31825d9f4b.
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| ISSN: | 1642-5758 |
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