title: Bilateral rectus sheath blocks as the single anaesthetic technique for an open infraumbilical hernia repair.
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.
authors.affiliation: Department of Anaesthesia, Changi General Hospital, 2 Simei Street 3, Singapore 529889. kelvin_quek@cgh.com.sg.
authors.forename: Kelvin How Yow
authors.initials: KH
authors.lastname: Quek
authors.forename: Darren Shing Kuan
authors.initials: DS
authors.lastname: Phua
mesh_terms: D000698:Analgesia; D000758:Anesthesia; D000776:Anesthesiology; D015992:Body Mass Index; D002045:Bupivacaine / Q000737:chemistry; D009202:Cardiomyopathies; D006439:Hemodynamics; D006554:Hernia, Umbilical / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008012:Lidocaine / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D017568:Rectus Abdominis / Q000473:pathology*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D008012:Lidocaine; D002045:Bupivacaine