Bilateral Rectus Sheath Block Research Articles

Umbilical Hernia Repair under Ultrasound Guided Bilateral Rectus Sheath Block: A Case Series

Usually reserved for high-risk patients, ultrasound guided bilateral rectus sheath block can be a very effective alternative for primary repair of umbilical hernia thereby reducing the morbidity and mortality associated with spinal or general anesthesia and providing adequate anesthesia and analgesia.

Assessment of an Ultrasound-Guided Rectus Sheath Block in Foals: A Cadaveric Study

In neonatal equines, pathologies involving umbilical structures are an important cause of morbidity, and surgical removal of urachal remnants is a common procedure in clinical practice. Surgery involving the ventral abdominal wall can cause substantial pain, leading to complications and prolonged recovery. The objectives of this study were to describe a two-point bilateral ultrasound-guided rectus sheath block at the level of the umbilicus and to evaluate the extent of dye distribution in foal cadavers. Ten foal cadavers were included in the study, in which a bilateral two-point ultrasound-guided rectus sheath block was performed—one injection 5 cm cranially and a second one 5 cm caudally to the umbilicus. The injectate consisted of a mixture of iodinated contrast medium and blue dye at a volume of 0.25 mL kg−1 per injection point (total 1 mL kg−1). After the injection, computer tomography and subsequent dissection of the ventral abdominal wall were performed. The extension of the contrast medium, the number of stained nerves, and contamination of the abdominal cavity were evaluated. The cranio-caudal extension of the contrast ranged from 0.8 to 1.4 cm per milliliter of injectate. The most commonly stained ventral branches of spinal nerves were thoracic (Th) nerves 16, 17, and 18 (95%, 85%, and 80% of the nerves, respectively). Abdominal contamination was found in four animals. The results suggest that the block could provide periumbilical analgesia. Further studies with different volumes of injectate and living animals are warranted.

Obstructed umbilical hernia repair under bilateral rectus sheath block for a high-risk patient: A case report

We present a case of an open hernia repair for an obstructed Umbilical Hernia for a 77-year-old male patient categorized as ASA 4E with multiple comorbidities under Bilateral Rectus Sheath Block.A bilateral rectus sheath block was performed under real-time ultrasonographic guidance. He is a known case of coronary artery disease and double vessel disease and was on dual antiplatelet therapy. Due to the patient’s significant perioperative risks, the surgery was performed under ultrasonography-guided bilateral rectus sheath block. The patient tolerated the surgery well, with minimal further sedation.

Cardiovascular changes, laboratory findings and pain scores in calves undergoing ultrasonography-guided bilateral rectus sheath block before herniorrhaphy: a prospective randomized clinical trial

BackgroundThe study aimed to assess the clinical utility of a multiparametric approach to measure the impact of bilateral ultrasound-guided rectus sheath blocks (RSB) on heart rate, serum cortisol concentrations, and pain in calves undergoing herniorraphy. Fourteen calves were randomly assigned to receive either the RSB (RSB group, n = 7, injected with 0.3 mL/kg of bupivacaine 0.25% and 0.15 µg/kg of dexmedetomidine per side) or a sham injection (CG group, n = 7, injected with an equivalent volume of sterile saline solution). Monitoring included (i) continuous Holter recording from 120 min pre-surgery to 120 min post-surgery; (ii) serum cortisol concentration (SC) at -150 min pre-surgery (baseline), induction time, skin incision, end of surgical procedure (EP-t), and then 30 min, 45 min, 60 min, 120 min, 360 min after recovery; (iii) UNESP-Botucatu pain evaluation at -150 min pre-surgery and 30 min, 45 min, 60 min, 120 min, 240 min, 360 min after recovery.ResultsA significant difference in the heart rate was observed within the RSB group, in the time frame between 120 min to induction compared to the time frame between induction to EP-t period. The SC concentration was significantly higher in the CG at the skin incision. Calves in the RSB group recorded significantly lower pain scores at 45 min, 60 min, 120 and 240 min after recovery.ConclusionsThe study demonstrated that monitoring heart rate and serum cortisol concentrations effectively quantified the effects of RSB during surgery. At the same time, the UNESP-Botucatu pain scale identified effects post-surgery when the calves regained consciousness. Overall, ultrasound-guided RSB appeared to enhance the well-being of calves undergoing herniorrhaphy.

FTP7.7 Does bilateral combined Transversus Abdominis Plane (TAP) and rectus sheath block reduce postoperative pain after “hot laparoscopic cholecystectomy” compared to trocar site local anaesthetic infiltration?

Abstract Introduction Post-operative pain is the commonest reason for prolonged hospital stay and readmission following laparoscopic cholecystectomy. We aim to assess whether bilateral transversus abdominis plane (TAP) and rectus sheath block reduces post-operative pain compared to local anaesthetic (LA) wound infiltration following “hot” laparoscopic cholecystectomies. Methods Prospective study involving 15 patients who underwent laparoscopic cholecystectomy in dedicated “hot lists” between October and December 2022. Post-operative pain scores were recorded 4 hours, 3 days, and 5 days post-procedure. Pain scores of patients who received bilateral TAP and rectus sheath blocks were compared with those who received LA wound infiltration with 0.5% Levobupivacaine. Results 9 patients received TAP and rectus sheath blocks, and 6 patients received LA infiltration. The time from start of anaesthesia to start of surgery in the TAP block group was significantly higher than the LA group (P=0.039). There was no statistical difference in pain scores on the pain analogue scale (1-10) between groups at 4 hours (P=0.73), 3 days (P=0.27), or 5 days (P=0.33) post-surgery. There was no statistical difference between the 2 groups in length of hospital stay post-procedure (P=0.75), or in re-admission rates due to poorly controlled post-operative pain (P=0.58). Conclusion Bilateral TAP and rectus sheath blocks do not significantly reduce pain post “hot laparoscopic cholecystectomy” any more than LA wound infiltration. Given the extra time taken to perform TAP and rectus sheath blocks, a larger study population would be required to more reliably assess their benefits, given the importance of avoiding overrunning of the “hot list”.

Comparison of analgesic efficacy of perineural dexamethasone in rectus sheath block and intravenous dexamethasone with levobupivacaine in bilateral rectus sheath block for patients undergoing midline abdominal surgery: a randomized controlled trial

BackgroundDexamethasone is used in regional analgesia to prolong the duration of analgesia and anaesthesia. The perineural and intravenous (IV) dexamethasone in fascial plane block have conflicting results. The study aimed to compare analgesic efficacy of perineurally and intravenously dexamethasone in rectus sheath block (RSB). This prospective, double-blinded, randomized control study was conducted in 105 patients, equally divided in three groups. All the patients received ultrasound-guided RSB block with 20 ml of 0.25% levobupivacaine on each side. Additionally, in group A, 1-ml normal saline (NS) on each side in RSB block and 2-ml NS IV; in group B, 4-mg dexamethasone on each side in RSB block and 2-ml NS IV; and in group C, 1-ml NS on each side in RSB block and 8-mg dexamethasone IV.The primary objective of the study was the duration of analgesia, and secondary objectives were total morphine consumption in the first 24 h, numeric rating scale (NRS) scores at rest and on cough, complications and patient’s satisfaction score.ResultsThe duration of analgesia was maximum in group B (935.91 ± 121.82 min) and then in group C (730.31 ± 129.64 min) and group A (418.34 ± 29.22 min) (P < 0.0001). The morphine consumption and mean NRS score (at rest and cough) were lowest in group B and then group C and group A (P < 0.0001).ConclusionsThe perineural dexamethasone as an adjuvant to levobupivacaine prolongs the duration of analgesia with decreased analgesic requirements compared to intravenous dexamethasone in bilateral RSB in patients undergoing midline laparotomy surgery.

Bilateral Rectus Sheath Block as an Effective Alternative Anaesthetic Technique for palliative Feeding Jejunostomy in an Advanced Carcinoma Thyroid Patient who Developed Tracheo - Oesophageal Fistula

Bilateral Rectus Sheath Block as an Effective Alternative Anaesthetic Technique for palliative Feeding Jejunostomy in an Advanced Carcinoma Thyroid Patient who Developed Tracheo - Oesophageal Fistula

Transversus Abdominis Plane Block Versus Rectus Sheath Block for Postoperative Pain After Caesarean Delivery: A Randomised Controlled Trial.

Postoperative analgesia in caesarean deliveries is becoming increasingly important, since early bonding between mother and infant can be established with effective postoperative analgesia while preventing the unpleasant effects of pain. Additionally, inadequate postoperative analgesia is associated with chronic pain and postpartum depression. The primary objective of this study was to compare the analgesic effects of transversus abdominis plane block and rectus sheath block in patients undergoing elective caesarean delivery. A total of 90 parturients with American Society of Anesthesia status I-II, aged 18-45 years, at >37 gestational weeks, and scheduled for elective caesarean delivery were included in the study. All patients received spinal anaesthesia. Parturients were randomised into 3 groups. Bilateral ultrasound-guided transversus abdominis plane block was performed on the transversus abdominis plane group, bilateral ultrasoundguided rectus sheath block on the rectus sheath group, and no block on the control group. All patients were given intravenous morphine through a patient-controlled analgesia device. A pain nurse, blinded to the study, recorded the cumulative morphine consumption and pain scores during resting and coughing using a numerical rating scale at postoperative hours 1, 6, 12, and 24. Numerical rating scale values recorded during rest and coughing were lower in the transversus abdominis plane group at postoperative hours 2, 3, 6, 12, and 24 (P < .05). Morphine consumption was lower in the transversus abdominis plane group at postoperative hours 1, 2, 3, 6, 12, and 24 (P < .05). Transversus abdominis plane block provides effective postoperative analgesia in parturients. However, rectus sheath block provides inadequate postoperative analgesia in parturients who undergo caesarean delivery.

Clinical efficacy of an ultrasound-guided bilateral rectus sheath block for umbilical hernia repair in calves: A prospective randomized trial.

Surgical umbilical hernia repair is a frequent procedure in newborn calves, requiring mandatory pain management. This study aimed to develop an ultrasound-guided rectus sheath block (RSB) and to evaluate its clinical efficacy in calves undergoing umbilical herniorrhaphy under general field anesthesia. Gross and ultrasound anatomy of the ventral abdomen and the diffusion of a new methylene blue solution after injection within the rectus sheath were described in seven fresh calf cadavers. Then, fourteen calves undergoing elective herniorrhaphy were randomly assigned to receive either bilateral ultrasound-guided RSB with 0.3 mL/kg of bupivacaine 0.25% and 0.15 µg/kg of dexmedetomidine or 0.3 mL/kg of 0.9% NaCl (control). Intraoperative data included cardiopulmonary variables and anesthetic requirements. Postoperative data included pain scores, sedation scores and peri-incisional mechanical threshold assessed by force algometry at specific time points after anesthetic recovery. Treatments were compared using Wilcoxon rank-sum, Student's t-test, and Cox proportional hazard model as appropriate. Mixed effect linear models on rank, with random effect calf; fixed effects time, treatment, and their interaction were used to compare pain scores and mechanical thresholds over time. Significance was set at p = 0.05. Calves receiving RSB recorded lower pain scores between 45 - 120 minutes (p < 0.05) and at 240 min after recovery (p = 0.02). And they recorded higher mechanical thresholds between 45 and 120 min after surgery (p < 0.05). Ultrasound-guided RSB provided effective perioperative analgesia in calves undergoing herniorrhaphy under field conditions.

Bilateral rectus sheath block as the sole anesthetic technique for urgent incarcerated umbilical hernia repair

Bilateral rectus sheath block as the sole anesthetic technique for urgent incarcerated umbilical hernia repair

Bilateral rectus sheath block as the sole anesthetic technique for urgent incarcerated umbilical hernia repair

El bloqueo de la vaina de los rectos es una técnica analgésica interesante para la reparación de la hernia umbilical y hay casos descritos donde incluso se ha usado como único anestésico. Describimos el caso clínico de un paciente que precisó reparación urgente de una hernia umbilical incarcerada y que fue manejado con éxito con un bloqueo de la vaina de los rectos bilateral junto con sedación ligera. El bloqueo ecoguiado de la vaina de los rectos bilateral aportó anestesia quirúrgica para nuestro paciente, evitando los riesgos de la anestesia general y espinal en su peculiar situación clínica y consiguió una analgesia posoperatoria excelente, una rápida recuperación y alta hospitalaria sin complicaciones.

Comparison of Postoperative Analgesic Efficacy of Ultrasound-Guided Bilateral Rectus Sheath Block With That of Local Anaesthetic Infiltration in Patients Undergoing Emergency Midline Laparotomy Surgeries: A Randomised Controlled Trial.

Purpose Rectus sheath block (RSB) is increasingly utilised as a part of multimodal analgesia in laparotomy surgeries. We proposed this study to compare the analgesic efficacy of ultrasound-guided bilateral RSB with local anaesthetic (LA) infiltration. The primary outcome was the visual analogue scale (VAS) at rest and cough. The secondary outcomes were the postoperative morphine consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV)and patient satisfaction score. Methods In our prospective, single-centre, randomised clinical trial, we enrolled a total of 100 patients undergoing emergency midline laparotomy surgeries. They were randomly allocated into two groups and were administered either LA infiltration (group L, n=50) or ultrasound-guided bilateral RSB (group R, n=50) with 15-20 ml of 0.25% bupivacaine end operatively.The categorical and ordinal variables were analysed using Chi-square/ Fisher's exact test. The continuous and discrete variables were analysed using Mann-Whitney/independent Student t-test. Results The median VAS scores in the postoperative period were significantly lower with RSB when compared with LA. Statistically significant differences in median VAS scores were noticed at one hour (P<0.001), four hours (P=0.001), eight hours (P<0.001), and 12 hours (P=0.014) at rest, and at one hour (P<0.001), four hours (P<0.001) and eight hours (P<0.001) during cough.The median morphine consumption was less with RSB (P<0.001). The time to first rescue analgesia was prolonged with RSB (P<0.001). The incidence of PONV was significantly lower with RSB (P=0.027). Conclusion Bilateral ultrasound-guided RSB provides extended postoperative analgesia at rest and cough for patients undergoing emergency laparotomy surgeries when compared with LA infiltration. There was a significant reduction in morphine consumption, incidence of PONV, and prolonged time to first rescue analgesia with RSB.

A Retrospective Comparison of Three Patient-Controlled Analgesic Strategies: Intravenous Opioid Analgesia Plus Abdominal Wall Nerve Blocks versus Epidural Analgesia versus Intravenous Opioid Analgesia Alone in Open Liver Surgery.

Background: Adequate pain control is of crucial importance to patient recovery and satisfaction following abdominal surgeries. The optimal analgesia regimen remains controversial in liver resections. Methods: Three groups of patients undergoing open hepatectomies were retrospectively analyzed, reviewing intravenous patient-controlled analgesia (IV-PCA) versus IV-PCA in addition to bilateral rectus sheath and subcostal transversus abdominis plane nerve blocks (IV-PCA + NBs) versus patient-controlled thoracic epidural analgesia (TEA). Patient-reported pain scores and clinical data were extracted and correlated with the method of analgesia. Outcomes included total morphine consumption and numerical rating scale (NRS) at rest and on movement over the first three postoperative days, time to remove the nasogastric tube and urinary catheter, time to commence on fluid and soft diet, and length of hospital stay. Results: The TEA group required less morphine over the first three postoperative days than IV-PCA and IV-PCA + NBs groups (9.21 ± 4.91 mg, 83.53 ± 49.51 mg, and 64.17 ± 31.96 mg, respectively, p < 0.001). Even though no statistical difference was demonstrated in NRS scores on the first three postoperative days at rest and on movement, the IV-PCA group showed delayed removal of urinary catheter (removal on postoperative day 4.93 ± 5.08, 3.87 ± 1.31, and 3.70 ± 1.30, respectively) and prolonged length of hospital stay (discharged on postoperative day 12.71 ± 7.26, 11.79 ± 5.71, and 10.02 ± 4.52, respectively) as compared to IV-PCA + NBs and TEA groups. Conclusions: For postoperative pain management, it is expected that the TEA group required the least amount of opioid; however, IV-PCA + NBs and TEA demonstrated comparable postoperative outcomes, namely, the time to remove nasogastric tube/urinary catheter, to start the diet, and the length of hospital stay. IV-PCA with NBs could thus be a reliable analgesic modality for patients undergoing open liver resections.

Analgesic efficacy of Clonidine as an adjuvant in ultrasound-guided rectus sheath block for midline incisional hernia repair - A randomized double-blind controlled trial.

Clonidine as an adjuvant has not been evaluated in rectus sheath block (RSB) for postoperative pain management in incisional hernia repair. The study aims to evaluate clonidine as an adjuvant in single-shot RSB along with general anesthesia (GA). This randomized, double-blind controlled study was conducted following IEC-Human approval and written informed consent from 30 patients of either sex, aged 16 to 60 years, ASA physical status I or II undergoing midline incisional hernia repair under GA. All patients received ultrasound-guided bilateral RSB following administration of GA. The subjects enrolled in the study were randomly allocated to receive either normal saline 1 mL (group B) or clonidine 1 μg/kg diluted to 1 mL with normal saline (group BC) as adjuvant along with 9 mL bupivacaine hydrochloride 0.25%. Inj. tramadol 1 mg/kg was administered for rescue analgesia. The primary outcome was the time to first request for analgesia, and secondary outcomes were total consumption of rescue analgesic over 24 h, numerical rating score (NRS), patients' satisfaction, hemodynamics, and side effects. Unpaired t-test and Chi-square test were used. On intergroup analysis, the mean time to first request for analgesia (in min) was significantly higher in group BC i.e., [9.60 (± 5.23) vs 5.33 (± 3.53); (P < 0.034]; whereas, the mean rescue analgesic consumption in 24 h (in mg) was higher in group B i.e., [(88.00 ± 60.97) vs (46.00 ± 48.08)]; (P < 0.045)]. Hemodynamic parameters i.e., mean blood pressure and heart rate were comparable between the two groups, and there were no side effects. Clonidine as an adjuvant in single-shot ultasonography (USG)-guided RSB along with GA is efficacious for postoperative pain management following midline incisional hernia repair.

Combination of Ultrasound-Guided Serratus Anterior Plane Block and Rectus Sheath Block Provide Analgesia for Open Hepatectomy: A Report on 3 Cases

Perioperative analgesia in open hepatectomy is challenging because a large subcostal arc incision is often required. Extensive dissection of muscles and nerves is associated with severe intraoperative hemodynamic fluctuations and postoperative pain. Serratus anterior plane block (SAPB) and rectus sheath block (RSB) are commonly used for anesthesia and postoperative analgesia in patients undergoing chest wall surgery and abdominal surgery, respectively. In this case-series report, we present our experience with three patients in whom open hepatectomy and early extubation were performed successfully under a combination of ultrasound-Guided SAPB and RSB. Three patients were scheduled for open hepatectomy, all of them were diagnosed with severe hepatitis B cirrhosis. After due deliberation and with the consent of patients and their family, ultrasound-guided right SAPB and bilateral RSB were performed with the patient in the supine position. A total of 0.7mL/kg of 0.25% ropivacaine was used for nerve block. Sensory loss to pinprick from T5 to T10 was achieved in all three patients 20 min after administration of blocks. The operation went smoothly for all the patients. All three patients experienced quiet recovery and early extubation, and none of them complained of discomfort in the surgical site in the first 12 h after surgery. Here we present three cases of a combination of ultrasound-guided SAPB and RSB that may be an attractive option for anesthetic management of open hepatectomy in clinical practice.

Ultrasound-guided bilateral rectus sheath block analgesia and neutrophil-lymphocytes ratio in adult with midline laparotomy at Sanglah General Hospital: Case series

This study aims to report our experience with ultrasound-guided bilateral rectus sheath block (RSB) in patients with midline laparotomy and evaluated neutrophil-lymphocytes ratio (NLR) value pre- and postoperatively. Midline laparotomy is associated with severe pain, high analgesia requirements, and inflammation after surgery. RSB is a simple and safe option for analgesia in midline laparotomy than other abdominal peripheral nerve blocks. In clinical studies, RSB has been shown to provide longer postoperative analgesia and less opioid consumption. General anesthesia and surgery is related with the activation of inflammatory responses. Peripheral nerve block is related to reduce inflammatory response, which NLR value is a simple marker to assess inflammatory response during perioperative period. Our case series included five patients undergoing laparotomy with bilateral RSB posterior approach. The range age of patients was 32–58 years old. After the induction of general anesthesia, RSB was performed by ultrasound guided. The Numeric Rating Scale (NRS), duration until first analgesia request postoperative and total opioid morphine consumption were recorded after surgery. NLR value was evaluated before and after surgery as the marker of inflammation. The results of NRS score were 0–2 in 24 h postoperative with range of total morphine consumption were 1–7 mg and duration of first analgesia request were 120–390 min. Our cases showed an increased NLR value 2–3 times postoperatively. No complication was found in these cases. Further study is needed to prove the effect of the RSB on the anti-inflammatory response.

Rectus sheath block and emergency midline laparotomy at a hospital in Ethiopia: A prospective observational study

BackgroundMidline laparotomy is associated with severe postoperative pain. Literature showed controversial results regarding the efficacy of the rectus sheath block. MethodsThis is a prospective cohort study that recruits 30 patients in the rectus sheath block (RSB) group and 30 patients in the multimodal analgesia (MMA) group who underwent emergency midline laparotomy. The RSB was performed by an experienced anesthetist using a land-mark technique. Independent t-test and Mann-Whitney-U test were used for numeric data while Chi-Square or Fisher exact test was used for categorical variables. P-values < 0.05 were considered as statistically significant. ResultsThe numeric rating scale score at the recovery was significantly reduced in an RSB group with a p-value of 0.039. Postoperative numeric rating scale scores at 3rd, 6th, 12th, and 24th hours were statistically significantly lower in the RSB group. Postoperative tramadol consumption in 24 h was significantly lower with a p-value of 0.0001 for the rectus sheath group. ConclusionsFor midline laparotomy, adding a bilateral rectus sheath block at the end of the operation might be an effective postoperative analgesia option.

Postoperative analgesic effect of ultrasound-guided rectus sheath block and local anesthetic infiltration after laparoscopic cholecystectomy: Results of a prospective randomized controlled trial.

Even if laparoscopic cholecystectomy (LC) has lower invasiveness through small incisions compared with laparotomy, postoperative pain control is important. This prospective, randomized, single-blinded, interventional, single-center study was conducted from December 2016 to March 2018 at the Shiga University of Medical Science Hospital in Japan. Enrolled patients were assigned to either a rectus sheath block (RSB) group or an infiltrative local anesthesia (LA) group. After LC, the RSB group received bilateral RSB with 10 mL of 0.375% ropivacaine and the LA group received subcutaneous and fascial injection with 10 mL of 0.75% ropivacaine at the umbilical wound. The primary endpoint was a visual analog scale (VAS) score on postoperative day (POD) 1. This study enrolled 62 patients (RSB group=31, LA group=31). On POD1, the mean VAS scores were 36.4 ± 18.9 and 29.4 ± 15.4 in the RSB group and LA groups, respectively, showing that the LA group tended to describe lesser postoperative pain than the RSB group (P=0.062). VAS scores on POD1 were not different between the groups. LC patients might obtain postoperative pain control via long-acting local analgesia.

Analgesic combination for robot assisted laparoscopic radical prostatectomy; transversus abdominis plane block and rectus sheath block: Where and how?

&lt;p class="abstract"&gt;One of the common arguments for advantages of minimally invasive surgery is reduced postoperative pain and faster recovery. Faster recovery is expected with less postoperative pain in robotic surgeries. Robot-assisted radical prostatectomy causes considerable discomfort, mainly during the first postoperative day. The discomfort originates from abdominal pain, bladder spasm and transurethral catheter irritation. We would like to share our experience on use of bilateral subcostal mid axillar TAP block and rectus sheath block for postoperative analgesia in five male patients who underwent robot assisted radical prostatectomy surgery. General anesthesia was performed with 2mg/kg propofol, 1 μg/kg fentanyl, 0.6 mg/kg rocuronium. Anesthesia was maintained by remifentanil infusion and 1 MAC desflurane. After the surgery, TAP block and rectus sheath block performed in supine position. Blocks were done under ultrasound guidance. After the block, patients were extubated. At the end of the surgery patients were administered 1g paracetamol and tramadol 50 mg intravenous. Patients had intravenous tramadol PCA (only bolus dose 10 mg). Rescue analgesia was planned as tramadol 50 mg boluses if VAS scores were above 4 in recovery unit. Neither patient required rescue analgesia nor PCA bolus doses in recovery unit. All patients were satisfied with the analgesia quality. TAP block and rectus sheet block is a very effective combination in robotic prostate surgeries. Perhaps the most important thing is the selection of the most effective analgesic method that contributes to the rapid recovery of the patient.&lt;/p&gt;

Orta Hat Laparotomisi Anestezisi İçin Ultrasonografi Eşliğinde Bilateral Rektus Kılıf Bloğu

Orta Hat Laparotomisi Anestezisi İçin Ultrasonografi Eşliğinde Bilateral Rektus Kılıf Bloğu