Background and Aims We present a case of regional anesthesiologists using ultrasound-guidance to strategically place Botox injections into the abdominal musculature to facilitate closure of a large ventral hernia. A male patient with complex abdominal surgical history that had previously failed abdominal wall reconstruction was scheduled for a reattempt at ventral wall closure and the surgeon consulted anesthesiology for Botox injections.

Methods Three weeks before the surgery, the patient presented to anesthesiology. His abdominal girth was measured at the umbilicus while relaxing(88.5cm) and while contracting(97cm) his musculature. Measurement of his defect across the umbilicus by palpation was 16cm. After monitors, IV placement and sedation the patient received Botox injections. Under ultrasound-guidance we identified three muscle layers; external oblique, internal oblique and transverse abdominis. We choose three sites per side for injection; a superior, middle and inferior site. Using a 22g Pajunk needle we placed 8 ml of Botox 2U/ml per muscle layer for a total of 300 units of Botox. The patient tolerated the procedure well.

Results At the time of surgery, the patient’s abdominal girth at the umbilicus with relaxation was(91cm) and contraction(105cm). Palpation of the hernia was measured at the umbilicus at 19cm. Demonstrating relaxation of abdominal musculature. The patient proceeded to surgery with successful closure.

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Abstract 94 Figure 1

Conclusions As the technological advances in ultrasound have advanced so has ultrasound-guided regional anesthesia and the role of the regional anesthesiologist. We bring forward this case report as an example of regional anesthesiologists’ expertise being utilized outside the traditional setting to facilitate better outcomes for surgical patients.