Bilateral rectus sheath blocks as the single anaesthetic technique for an open infraumbilical hernia repair.
- Author:
Kelvin How Yow QUEK
1
;
Darren Shing Kuan PHUA
Author Information
1. Department of Anaesthesia, Changi General Hospital, 2 Simei Street 3, Singapore 529889. kelvin_quek@cgh.com.sg.
- Publication Type:Case Reports
- MeSH:
Analgesia;
Anesthesia;
Anesthesiology;
Body Mass Index;
Bupivacaine;
chemistry;
Cardiomyopathies;
Hemodynamics;
Hernia, Umbilical;
surgery;
Herniorrhaphy;
methods;
Humans;
Lidocaine;
chemistry;
Male;
Middle Aged;
Nerve Block;
methods;
Rectus Abdominis;
pathology;
Treatment Outcome;
Ultrasonography
- From:Singapore medical journal
2014;55(3):e39-41
- CountrySingapore
- Language:English
-
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.
