Patient Position: Supine.
Indications: Intra- and postoperative analgesia for umbilical and paraumbilical hernia repair.
Needle Size: A short beveled needle.
Volume: 0.2 mL/kg of ropivacaine 0.2% for children up to 7 years, levobupivacaine 0.5% for older children.
Anatomic Landmarks: Umbilicus, rectus abdominis muscles (Fig. 53-1).
Approach and Technique: The external layer of the rectus sheath on both sides of the abdomen is marked. A short beveled needle is then introduced at the crossing of the outer border of this muscle with the horizontal line passing over the umbilicus. The needle is introduced and advanced at a 60° angle to the skin in the direction of the umbilicus until there is a loss resistance, corresponding to the piercing of the rectus sheath. This piercing is clearly identified by a “pop” because the sheath is rather resistant. After the injection of the volume of local anesthetic the same technique is repeated on the other side.
1. The paraumbilical area is innervated by branches of the 10th intercostal nerves after they have penetrated the rectus sheath, which covers the rectus abdominis muscle.
2. This technique is quite simple, virtually free of complications and its success rate is very high.
Figure 53-1. Umbilicus, rectus abdominis muscles.
Courrèges P, Poddevin F, Lecoutre D. Para-umbilical block: a new concept for regional anaesthesia in children. Paediatr Anaesth 1997;7:211.
Ferguson S, Thomas V, Lewis I. The rectus sheath block in paediatric anaesthesia: new indications for an old technique? Paediatr Anaesth 1996;6:463.
Willschke H, Bosenberg A, Marhofer P, et al. Ultrasonography-guided rectus sheath block in paediatric anaesthesia—a new approach to an old technique. Br J Anaesth 2006;97(2):244–249.