Continuous rectus sheath block in a patient with a postoperative rectus sheath hematoma: a case report

Sho Kumita,Michiaki Yamakage,Takahiro Ichimiya,Shunsuke Tachibana

doi:10.1186/s40981-019-0236-z

Sho Kumita, Michiaki Yamakage + Show 2 more

Open Access

https://doi.org/10.1186/s40981-019-0236-z

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Abstract

BackgroundSevere abdominal pain caused by a rectus sheath hematoma (RSH) can decrease a patient’s activities of daily living. A case of postoperative RSH for which a continuous rectus sheath block (RSB) was effective is reported.Case presentationA 62-year-old woman who had no previous medical history underwent hysterectomy, total cystectomy, and ileal conduit surgery for bladder cancer under epidural and general anesthesia. She complained of severe abdominal pain 40 min after removal of the epidural catheter on postoperative day (POD) 4. Computed tomography showed an RSH on POD 12. For pain relief, an ultrasound-guided continuous RSB was performed on POD 17. After the block, the numerical rating scale (NRS) score during movement decreased immediately (from 10 to 2 or 3), and she had no further need for oral or intravenous analgesics. She was discharged from the hospital without any complications on POD 28.ConclusionsContinuous RSB can be an effective technique for pain relief of postoperative RSH.

Highlights

Severe abdominal pain caused by a rectus sheath hematoma (RSH) can decrease a patient’s activities of daily living
Continuous rectus sheath block (RSB) can be an effective technique for pain relief of postoperative RSH
On postoperative day (POD) 4, she complained of severe abdominal pain (numerical rating scale (NRS) score: 10/10) 40 min after removal of the epidural catheter

Summary

Introduction

Severe abdominal pain caused by a rectus sheath hematoma (RSH) can decrease a patient’s activities of daily living. Conclusions: Continuous RSB can be an effective technique for pain relief of postoperative RSH. Background A rectus sheath hematoma (RSH) is caused by damage to epigastric vessels and/or the rectus muscle. Conservative management is selected in hemodynamically stable RSH cases; abdominal pain is usually described as severe, sharp, and persistent [1].

Results

Conclusion