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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims To report a case of a bilateral ultrasound-guided rectus sheath block used as the main anesthetic technique in a patient with ASA score III undergoing umbilical hernia repair surgery.
Methods A 75-year-old patient with a history of severe COPD (FEV-1 Pred. = 36%), pulmonary hypertension (PASP = 60mmHg), atrial fibrillation, hypertension, diabetes mellitus and a BMI of 40.4 kg/m2, came in for umbilical hernia repair surgery. Due to the patient’s significant perioperative risks, a bilateral ultrasound-guided rectus sheath block was elected as the main anesthetic technique. Preoperatively, under sterile conditions, with the patient in supine position, a low-frequency curvilinear transducer was placed transversely above the umbilicus approximately 1 cm lateral to the midline. The rectus abdominis muscle (RAM) and posterior rectus sheath were identified. The needle was inserted in-plane and guided through the RAM until the tip was placed posterior to the RAM and anterior to the posterior sheath, where 25ml of ropivacaine 0,375% was administered. The technique was repeated on the contralateral side.
Results Sensory block of dermatomes T9-T11 was achieved. The surgery was well tolerated with minimal IV sedation (20mg of ketamine and 2 mg of midazolam) and additional local infiltration of 20ml lidocaine 1,5%. No adverse effects were recorded.
Ultrasound-guided rectus sheath block technique
Rectus sheath block: Ultrasound image
Umbilical hernia repair surgery: T9-T11 sensory block
Conclusions Bilateral ultrasound-guided rectus sheath block is an effective regional technique, allowing this high-risk patient to undergo umbilical hernia repair surgery, while avoiding general anesthesia and central neuraxial blockade.