How to Perform a Rectus Sheath Block

Objective 

Injection of local anaesthetic deep to the Rectus Muscle and superficial to the Transversalis Fascia. The Rectus Block targets the 9th, 10th and 11th intercostal nerves traversing the anterior abdominal wall.

Technique:

• Begin by placing the ultrasound transducer immediately subcostal, transverse and midline on the abdominal wall to identify the Linea Alba and the Rectus Muscles bilaterally.
• Move the transducer lateral to the centre of a Rectus Muscle.
• The Anterior Rectus Sheath, Rectus Muscle, Transversalis Fascia and Peritoneum are easily identified by ultrasound.
• Use an in-plane medial to lateral approach. The block needle is inserted until it rests just superficial to the Transversalis Fascia and deep to the Rectus Muscle.
• The injection should spread medial and lateral, deep to the Rectus Muscle and superficial to the Transversalis Fascia.

Image

Patient Positioning: 

Supine 

Transducer: 

L12-3, L15-4 

Teaching Points:

• The Rectus Block provides analgesia to the anterior abdominal wall.
• The Rectus Block provides only somatic analgesia. It does not provide visceral analgesia.
• The Rectus Block will provide analgesia for umbilical hernia repair and or open midline abdominal wall incisions.
• The Rectus Block may be performed with the TAP Block to maximize coverage of the abdominal wall.

Conclusion:

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