Spread patterns and effectiveness for surgery after ultrasound-guided rectus sheath block in adult day-case patients scheduled for umbilical hernia repair.
OBJECTIVE
We conducted a prospective study to examine the local anesthetic (LA) spread and the effectiveness for surgical anesthesia of ultrasound (US)-guided rectus sheath block (RSB) in adult patients undergoing umbilical hernia repair.


METHODS
Thirty patients received at T-10 level a bilateral US-guided injection of 20 mL levobupivacaine 0.375% + epinephrine 5 μg/mL behind the rectus muscle to detach it from its sheath. Anesthetic spread into the rectus sheath was evaluated ultrasonographically at T-9 and T-11 levels and scored from 0 to 4. The RSB was defined effective for surgical anesthesia if it was able to guarantee an anesthetic level sufficient for surgery without any mepivacaine supplementation.


RESULTS
Overall, the block was effective for surgical anesthesia in 53.3% of patients (95% confidence interval, ±17.8). In the remaining patients, anesthesia supplementation was needed at cutaneous incision, whereas manipulation of the muscle and fascial planes was painless. No patients required general anesthesia. LA spreads as advocated (to T-9 and to T-11 bilaterally = spread score 4) in 8/30 patients (26.6%); in these cases, the block was 75% effective for surgery. The anesthetic spread was most negatively influenced by increased body mass index. Postoperative analgesia was excellent in 97% of patients.


CONCLUSIONS
Use of RSB as an anesthetic management of umbilical herniorrhaphy is recommended only with anesthetic supplementation at the incision site.
Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy.
Alberto
A
Manassero
Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy.
Matteo
M
Bossolasco
Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy.
Maurizio
M
Meineri
Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy.
Susanna
S
Ugues
Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy.
Chrysoula
C
Liarou
Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy.
Luca
L
Bertolaccini
Rectus sheath block; ultrasound-guided; umbilical hernia repair