1.Bilateral rectus sheath blocks as the single anaesthetic technique for an open infraumbilical hernia repair.
Kelvin How Yow QUEK ; Darren Shing Kuan PHUA
Singapore medical journal 2014;55(3):e39-41
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.
Analgesia
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Anesthesia
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Anesthesiology
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Body Mass Index
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Bupivacaine
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chemistry
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Cardiomyopathies
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Hemodynamics
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Hernia, Umbilical
;
surgery
;
Herniorrhaphy
;
methods
;
Humans
;
Lidocaine
;
chemistry
;
Male
;
Middle Aged
;
Nerve Block
;
methods
;
Rectus Abdominis
;
pathology
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Treatment Outcome
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Ultrasonography