<br />
Ultrasound<br />
Ultrasound-guided<br />
rectus sheath block<br />
Philips tutorial<br />
Francis V. Salinas, MD<br />
Staff Anesthesiologist and Section Head of Orthopedic Anesthesia<br />
Deputy Chief of Anesthesia<br />
Virginia Mason Medical Center<br />
Contents<br />
Ultrasound-guided rectus sheath block<br />
1 Introduction 3<br />
2 Indications 7<br />
3 Clinical anatomy 8<br />
4 Ultrasound anatomy and technique 14<br />
5 Clinical pearls and tips 45<br />
6 References 48<br />
Additional resources 49<br />
2 Contents<br />
1 Introduction<br />
The sensorimotor innervation of the anterior abdominal wall<br />
is supplied by the ventral rami of the <a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 1" href="http://viewer.zmags.com/publication/38da3aa6?page=1"> Ultrasound Ultrasound-guided rectus sheath bloc</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 2" href="http://viewer.zmags.com/publication/38da3aa6?page=2"> Contents Ultrasound-guided rectus sheath block </a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 3" href="http://viewer.zmags.com/publication/38da3aa6?page=3"> 1 Introduction The sensorimotor innerv</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 4" href="http://viewer.zmags.com/publication/38da3aa6?page=4"> Rect (ante Re Rectu (post Tran R Rec</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 5" href="http://viewer.zmags.com/publication/38da3aa6?page=5"> Anterior cutaneous branch Lateral cutaneo</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 6" href="http://viewer.zmags.com/publication/38da3aa6?page=6"> The thoracolumbar nerves pierce the lateral margi</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 7" href="http://viewer.zmags.com/publication/38da3aa6?page=7"> 2 Indications Ultrasound-guided RSBs can p</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 8" href="http://viewer.zmags.com/publication/38da3aa6?page=8"> 3 Clinical anatomy Rectus sheath The pair</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 9" href="http://viewer.zmags.com/publication/38da3aa6?page=9"> The anterior and posterior lamina of the EOM and </a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 10" href="http://viewer.zmags.com/publication/38da3aa6?page=10"> Rectus sheath (anterior portion) Linea semilun</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 11" href="http://viewer.zmags.com/publication/38da3aa6?page=11"> Rectus sheath (anterior portion) Linea semilun</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 12" href="http://viewer.zmags.com/publication/38da3aa6?page=12"> Above the level of the arcuate line the posterior</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 13" href="http://viewer.zmags.com/publication/38da3aa6?page=13"> Location of the thoracolumbar nerves within the r</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 14" href="http://viewer.zmags.com/publication/38da3aa6?page=14"> 4 Ultrasound anatomy and technique Shor</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 15" href="http://viewer.zmags.com/publication/38da3aa6?page=15"> [Figure 4a] The abdomen is exposed between the co</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 16" href="http://viewer.zmags.com/publication/38da3aa6?page=16"> [Figure 4b] The transducer is positioned lateral </a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 17" href="http://viewer.zmags.com/publication/38da3aa6?page=17"> Identification of the layers of the anterior abdo</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 18" href="http://viewer.zmags.com/publication/38da3aa6?page=18"> [Figure 5b] Sonoanatomy of the left RAM and the r</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 19" href="http://viewer.zmags.com/publication/38da3aa6?page=19"> [Figure 5c] Sonoanatomy of the right rectus abdom</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 20" href="http://viewer.zmags.com/publication/38da3aa6?page=20"> [Figure 5d] Sonoanatomy of the right rectus abdom</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 21" href="http://viewer.zmags.com/publication/38da3aa6?page=21"> [Figure 5e] Color flow Doppler image of Figure 5d</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 22" href="http://viewer.zmags.com/publication/38da3aa6?page=22"> Video 1 The transducer is initially placed over t</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 23" href="http://viewer.zmags.com/publication/38da3aa6?page=23"> [ Video 1 ] </a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 24" href="http://viewer.zmags.com/publication/38da3aa6?page=24"> Video 2 The transducer is placed over the right R</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 25" href="http://viewer.zmags.com/publication/38da3aa6?page=25"> [ Video 2 ] </a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 26" href="http://viewer.zmags.com/publication/38da3aa6?page=26"> · Identification of the layers of the anterior ab</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 27" href="http://viewer.zmags.com/publication/38da3aa6?page=27"> – The deep superior epigastric (above the umbili</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 28" href="http://viewer.zmags.com/publication/38da3aa6?page=28"> · The target site for needle tip placement is dee</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 29" href="http://viewer.zmags.com/publication/38da3aa6?page=29"> Single-injection technique · After the desired t</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 30" href="http://viewer.zmags.com/publication/38da3aa6?page=30"> [Figure 6a] The block needle is inserted 3-6 cm l</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 31" href="http://viewer.zmags.com/publication/38da3aa6?page=31"> · The needle is advanced and is observed advancin</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 32" href="http://viewer.zmags.com/publication/38da3aa6?page=32"> [Figure 7a] The needle tip is in the lateral aspe</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 33" href="http://viewer.zmags.com/publication/38da3aa6?page=33"> – After correct needle tip placement is confirme</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 34" href="http://viewer.zmags.com/publication/38da3aa6?page=34"> [Figure 7b] The needle tip is advanced further me</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 35" href="http://viewer.zmags.com/publication/38da3aa6?page=35"> [Figure 7c] The needle tip is advanced even furth</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 36" href="http://viewer.zmags.com/publication/38da3aa6?page=36"> Video 3 A single-injection RSB of the left RAM is</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 37" href="http://viewer.zmags.com/publication/38da3aa6?page=37"> [ Video 3 ] </a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 38" href="http://viewer.zmags.com/publication/38da3aa6?page=38"> Video 4 A single-injection RSB of the both the le</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 39" href="http://viewer.zmags.com/publication/38da3aa6?page=39"> [ Video 4 ] </a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 40" href="http://viewer.zmags.com/publication/38da3aa6?page=40"> Video 5 A continuous upper abdominal (T8 level) l</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 41" href="http://viewer.zmags.com/publication/38da3aa6?page=41"> [ Video 5 ] </a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 42" href="http://viewer.zmags.com/publication/38da3aa6?page=42"> Video 6 A continuous lower abdominal (T11 level) </a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 43" href="http://viewer.zmags.com/publication/38da3aa6?page=43"> [ Video 6 ] </a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 44" href="http://viewer.zmags.com/publication/38da3aa6?page=44"> Continuous-catheter technique · If a continuous-</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 45" href="http://viewer.zmags.com/publication/38da3aa6?page=45"> 5 Clinical pearls and tips · The ultrasoun</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 46" href="http://viewer.zmags.com/publication/38da3aa6?page=46"> · Local anesthetic selection – For bilateral s</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 47" href="http://viewer.zmags.com/publication/38da3aa6?page=47"> · The role of ultrasound-guided RSBs in periopera</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 48" href="http://viewer.zmags.com/publication/38da3aa6?page=48"> 6 References 1 Kata J, Ueda K, Kondo Y, et</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 49" href="http://viewer.zmags.com/publication/38da3aa6?page=49"> Additional resources For additional resourc</a>
<a title="Philips_RectusSheathBlockTutorial_FNL_Zmag page 50" href="http://viewer.zmags.com/publication/38da3aa6?page=50"> This paper reflects the opinion of the author, no</a>