Author(s): ,
Zabauski, D.*
Health education North West, Anaesthetic rotation, Manchester, United Kingdom
Biswas, A.
Health Education North West, ACCS rotation, Manchester, United Kingdom
Hulgur, M.D.
Wrightington- Wigan and Leigh NHS Foundation Trust, Anaesthetic Deepartment, Wigan, United Kingdom
ESRA Academy. Zabauski D. Sep 13, 2017; 190707; 365 Topic: Peripheral Nerve Blocks
Dzmitry Zabauski
Dzmitry Zabauski

Access to Premium content is currently a membership benefit.

Click here to join ESRA or renew your membership.

Discussion Forum (0)
Rate & Comment (0)
Background and Aims:

We describe a case of an open surgical repair of a paraumbilical hernia performed under rectus sheath block.


The patient gave his consent for this presentation.


Mr S was a 75 year old gentleman who was admitted to a medical ward with an infective exacerbation of COPD. His past medical history was significant and included brochiectasis, severe COPD on 24 hours oxygen therapy, atrial fibrillation, pulmonary embolysm. His exercise tolerance was few metres. During the admission he developed abdominal pain and was diagnosed with an incarcerated paraumbilical hernia. Anaesthetic review concluded that he was a very high risk patient for a general anaesthetic. Therefore it was decided to perform the surgery under rectus sheath block. Under ultrasound guidance 10 ml of 0.5% bupivacaine was administered between the rectus abdominis muscle and posterior rectus sheath on each side. The surgeons supplemented the block by infiltrating the skin and subcutaneous tissues with 15 ml 1% lidocaine with adrenaline. A defect about 1 cm was found, the sac contained the omentum and extraperitoneal fat. Intraoperatively the patient was given 1 g IV paracetamol, but no sedation or any further analgesia. He remained comfortable and pain free throughout the surgery.


Advances in regional anaesthesia have made it possible to anaesthetise patients with significant medical co-morbidities.

Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.

Save Settings