Background and Aims Rectus sheath block (RSB) is a regional anesthesia technique, that provides somatic analgesia (without visceral analgesia) by blocking the ventral rami of the 7th to 12 th intercostal nerves with injection of local anesthetic in the space between the rectus abdominis muscle and the posterior rectus sheath.¹ It can be used as a part of multimodal analgesia together with usage of non-opioid drugs, such as lidocaine, ketamine and magnesium, given as a continuous intravenous infusion during midline incisions in emergency open abdominal surgeries.Multimodal analgesia is recommended for pain management following major surgery.²

Methods We are presenting four cases of emergency open abdominal surgeries where bilateral RSB was performed with 0.25% bupivacaine after induction to general anesthesia.All patients received 4 mg dexamethasone and a continuous intravenous infusion with 2 mg/kg/h lidocaine, 0.2 mg/kg/h ketamine and 20 mg/kg/h was given till the end of surgery.All patient received 1 gr metamizole at the end of operation. In the postoperative period pain was followed with Visual Analogue Scale (VAS) score 2, 6, 12, 24, 36, 48 and 72 hours after operation and analgesia regime included metamizole 1 gr four times a day.For pain of 6–10/10 1 mg/kg tramadol was given.

Results During surgery request for opioids was lower and pain scores in the first 72 hours after surgery were reduced too.

Conclusions Bilateral rectus sheath block with continuous intravenous infusion of lidocaine,ketamine and magnesium provides sufficient analgesia during emergency laparotomies,lower opioid requirements during and after surgery,prolong neuromuscular block and all patient were hemodynamically stabile.