Rectus Sheath

by | Sep 4, 2021

Indications

  • Abdominal wall lacerations or injuries
  • Abdominal wall abscess incision and drainage

Contraindications

  • Infection overlying injection site
  • Allergy to local anesthetic

Equipment

  • 10cc of local anesthetic of choice diluted with 5-10cc of normal saline
  • 20-22G needle (or spinal needle)
  • Cleansing solution
  • Ultrasound with high-frequency linear transducer
  • Ultrasound transducer sterile cover

Preparation

Position

Position the patient supine

Ultrasound

Landmarks

  1. Position the transducer in transverse orientation cephalad and lateral to the umbilicus
  2. Identify the linea alba and the anterior and posterior portions of the rectus sheath surrounding the rectus abdominis muscle
  3. Use color Doppler to identify and avoid epigastric arteries

Technique

Dotted line showing area of anesthesia after bilateral block. Arrow shows needle trajectory towards posterior rectus sheath.

  1. In-plane needle visualization
  2. Enter from medial-to-lateral
  3. Advance needle towards the posterior rectus sheath
  4. Inject small aliquots of local anesthetic or normal saline to confirm correct position (between rectus abdominis muscle and posterior rectus sheath)
  5. Deposit remainder of local anesthetic
  6. Repeat on contralateral side

Source

  1. Highland Ultrasound