Development of a novel technique for bilateral rectus sheath nerve blocks under laparoscopic-guidance.
BACKGROUND
Bilateral rectus sheath blocks have proven to be superior to local anesthetic infiltration for umbilical incisions and have been gaining popularity for the treatment of perioperative pain in children. We aim to develop a technique of surgeon performed rectus sheath blocks under laparoscopic-guidance alone.


METHODS
In phase I, we observed the laparoscopic appearance of a rectus sheath block. The pain management team performed an ultrasound-guided rectus sheath nerve block as we visualized the posterior rectus sheath with the laparoscope. In phase II, after completion of the laparoscopic procedure, we performed a rectus sheath nerve block. Ultrasound was used to identify where the local anesthetic had been injected.


RESULTS
Nineteen patients were included in this study, accounting for 38 rectus sheath blocks. In phase I, we observed with the laparoscope the delivery of ten ultrasound-guided rectus sheath blocks. In phase II, 28 laparoscopic-guided rectus sheath blocks were completed with immediate ultrasound confirmation of correct placement.


CONCLUSIONS
We have demonstrated that the rectus sheath nerve block can be performed reliably under laparoscopic-guidance alone. The efficacy of the laparoscopic-guided nerve block compared to the ultrasound-guided approach will need further study in a prospective, randomized trial.


METHODS
Retrospective review.


METHODS
3.
Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Alessandra
A
Landmann
Department of Pediatric Anesthesiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Mihaela
M
Visoiu
Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, United States. Electronic address: marcus.malek@chp.edu.
Marcus M
MM
Malek
D000779:Anesthetics, Local / Q000008:administration & dosage*; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009407:Nerve Block / Q000379:methods*; D017063:Outcome Assessment, Health Care; D017568:Rectus Abdominis / Q000000981:diagnostic imaging / Q000294:innervation* / Q000601:surgery; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
D000779:Anesthetics, Local
Rectus sheath block; Surgeon-performed