A Unique Case Report of Bilateral Rectus Sheath Block as a Sole Anaesthetic Technique for Umbilical Hernia Repair

Abstract

Background: Rectus sheath block has been traditionally used to provide analgesia for anterior abdominal wall surgeries, as it spares the visceral pain component. It’s been used efficiently for intraoperative, post-operative analgesia, providing stable hemodynamic. The emergence of ultrasound has potentially increased the rate of success, while avoiding complications like bleeding, peritoneal puncture, visceral injury. Objective: The author successfully used bilateral rectus sheath block for anesthesia of umbilical hernia repair about which very sparsely is described in literature. The use of ultrasound has increased the accuracy while decreasing the rate of complications. Also complications associated with general anesthesia and central neruaxial block can be avoided. Method: Obstructed umbilical hernia repair and ventral hernia repair were performed under sole ultrasound guided rectus sheath block. 5ml of 2% xylocard and 10ml of 0.75% ropivacaine was deposited on each side between rectus abdominis muscle and posterior rectus sheath. Both were high risk cases and some length of bowel handling was also involved. Yet the patients were comfortable with minimal supplemental analgesics and did not complain of any pain. Conclusion: Bilateral rectus sheath block can provide adequate anesthesia for abdominal hernia surgeries involving some bowel handling if supplemented by intravenous analgesics in high-risk cases. Thus avoiding general anesthesia and central neuraxial blockade.