Because the rectus sheath muscle peels off the rectus fascia so easy, I have used the ultrasound transducer to move around the injected local under ultrasound dynamic visualization to spread it cephalad or caudad when the spread was not ideal on initial injection with great analgesia.
Great video, as always! I'm just wondering, how low can we get with the LA concentration in this block? We've been using 0,25% ropivacaine at my institution since that's the lowest recommended concentration for this block in the literature I've seen. But given those are small nerves we're blocking, I'd be tempted to go down to as low as 0,1%, and administer larger volumes to ensure optimal spread.
Fantastic video, I'm on a RAAPM duke vids marathon. In your experience, for whipples, ex lap procedures, if you were to do a TAP, would you perform 4 quadrants rather than a traditional bilateral TAPs (assuming you can't do Epidural)? And if you do 4 quadrants, would you do 2 lateral TAPs + 2 subcostal TAPs, or would you do 2 lateral TAPs + 2 rectus sheaths? I haven't found much literature to say which would be superior. With 4 quadrants you cover higher dermatomes with subcostal, or better midline coverage with rectus sheaths, but you use less volume in each quadrant. Appreciate your thoughts!
I guess you are an opiod agonist? Plan A analgesia should always involve block of some description. Most blocks are safe to do with enough experience barring maybe paravertebral or intercostal nerve block. I am not including neuroaxial blocks because everyone should be able to do those barring maybe cervical epidural
On what grounds? This is first line analgesia for midline surgery and has been demonstrated to significantly reduce recovery time, opioid use and duration of admission.
Extremely safe. Check this cohort study with 4033 patients: Kwon HJ, Kim YJ, Kim Y, Kim S, Cho H, Lee JH, Kim DH, Jeong SM. Complications and Technical Consideration of Ultrasound-Guided Rectus Sheath Blocks: A Retrospective Analysis of 4033 Patients. Anesth Analg. 2023 Feb 1;136(2):365-372. doi: 10.1213/ANE.0000000000006282. Epub 2022 Nov 29. PMID: 36638514.
Love this channel. Been using it to study for a while. Absolutely brilliant. Thank you for your hard work!❤
Glad you enjoy it! Thanks for watching!
Because the rectus sheath muscle peels off the rectus fascia so easy, I have used the ultrasound transducer to move around the injected local under ultrasound dynamic visualization to spread it cephalad or caudad when the spread was not ideal on initial injection with great analgesia.
Excellent video! Short and straight to the point with very clear imaging?
Great video, as always! I'm just wondering, how low can we get with the LA concentration in this block? We've been using 0,25% ropivacaine at my institution since that's the lowest recommended concentration for this block in the literature I've seen. But given those are small nerves we're blocking, I'd be tempted to go down to as low as 0,1%, and administer larger volumes to ensure optimal spread.
Fantastic video, I'm on a RAAPM duke vids marathon. In your experience, for whipples, ex lap procedures, if you were to do a TAP, would you perform 4 quadrants rather than a traditional bilateral TAPs (assuming you can't do Epidural)? And if you do 4 quadrants, would you do 2 lateral TAPs + 2 subcostal TAPs, or would you do 2 lateral TAPs + 2 rectus sheaths? I haven't found much literature to say which would be superior. With 4 quadrants you cover higher dermatomes with subcostal, or better midline coverage with rectus sheaths, but you use less volume in each quadrant. Appreciate your thoughts!
I've had more success anecdotally with rectus sheath than lateral TAP for midline pain. Am interested in RAAPM's response.
Total 80 mls LA?
Is it sensible to do RS block without a catheter? I remember reading once it lasting only about 6hrs as single shot.
what local anesthetic and concentration would you use for a volume of 80mL for 4 injections?
Can you do the video for catheter rectus sheet block? THANK YOU!
Do you use a fresh needle for the opposite side?
Nope, if you keep the needle sterile you can prep the skin on both sides and use the same needle for both. Thanks for watching!
Can rectus sheath cover dermatomes below Th11? Midline incision from umbilicus to pubic symphisis?
From T7 to L1.
Too risky!
I guess you are an opiod agonist? Plan A analgesia should always involve block of some description. Most blocks are safe to do with enough experience barring maybe paravertebral or intercostal nerve block. I am not including neuroaxial blocks because everyone should be able to do those barring maybe cervical epidural
On what grounds? This is first line analgesia for midline surgery and has been demonstrated to significantly reduce recovery time, opioid use and duration of admission.
Why? Proximity to peritoneum? It’s not a trocar.
Extremely safe. Check this cohort study with 4033 patients:
Kwon HJ, Kim YJ, Kim Y, Kim S, Cho H, Lee JH, Kim DH, Jeong SM. Complications and Technical Consideration of Ultrasound-Guided Rectus Sheath Blocks: A Retrospective Analysis of 4033 Patients. Anesth Analg. 2023 Feb 1;136(2):365-372. doi: 10.1213/ANE.0000000000006282. Epub 2022 Nov 29. PMID: 36638514.