
3D/AR Needle Insertion ©
Interactive 3D Model Control: Simply use your cursor to rotate the 3D model and explore probe positioning from every angle.
Immersive AR Experience: For an even more immersive experience, click the AR icon in the top right corner of the image. A QR code will appear—open your phone’s camera and scan it. This will take you to our secure AR platform, 'learn.arira.us'.
Bring the 3D Model to Your Room: When prompted, tap “Allow” to view the 3D model. Then, point your phone at a clear surface to project the model and explore it from any perspective.
The Best Seat in the Course: You’re always in the front row, and nothing beats this view!
Rectus Sheath Block
Needle Approach
In-Plane Technique: The needle is usually inserted using an in-plane technique relative to the ultrasound probe. This approach allows for continuous visualisation of the needle as it advances toward the target area within the rectus sheath. Maintaining the needle within the ultrasound plane ensures precise needle control and accurate delivery of the local anaesthetic.
Steps for Needle Insertion
Insertion Location: The needle is typically inserted lateral to the rectus abdominis muscle, in line with the ultrasound probe, and directed towards the posterior layer of the rectus sheath. The exact point of entry may vary depending on the specific region of the abdomen being targeted, but it is generally above the level of the umbilicus.
Needle Path for Bilateral Rectus Sheath Block: For the first side of the block, the needle is advanced from lateral to medial, with the goal of placing the tip between the posterior aspect of the rectus abdominis muscle and the posterior rectus sheath. The needle should navigate through the subcutaneous tissue, avoiding any vascular structures, until it reaches the target fascial plane. When performing the block on the contralateral side, instead of repositioning the ultrasound machine and operator, the probe is simply moved from the midline to the contralateral side of the abdomen. This time, the needle can be inserted medial to lateral. This technique is efficient, as it avoids the need to physically move the ultrasound machine or adjust the operator’s position.
Insertion Angle: Insert the needle at a shallow angle, typically between 10-30 degrees relative to the skin surface. This angle helps keep the needle tip visible within the ultrasound beam and aligned with the fascial plane of the posterior rectus sheath.
Target Location: The target area for the needle tip is just above the posterior rectus sheath, between this sheath and the rectus abdominis muscle. In this location, the local anaesthetic can effectively spread within the rectus sheath to block the anterior cutaneous branches of the lower thoracic nerves.
Aspirate and Inject: Once the needle is correctly positioned, aspirate gently to ensure it is not in a blood vessel. If clear, inject a small test dose of local anaesthetic to confirm the correct placement. The local anaesthetic should create a separation between the rectus abdominis muscle and the posterior rectus sheath.
Monitor Spread: As the full dose of local anaesthetic is injected, monitor the spread on the ultrasound. The anaesthetic should spread evenly along the fascial plane within the rectus sheath, providing effective coverage of the targeted nerves.
Final Check: After completing the injection, perform a final ultrasound scan to confirm that the local anaesthetic has adequately spread within the target plane and that the needle has not moved during the procedure.
Key Considerations
Avoid Intravascular Injection: Always aspirate before injecting the local anaesthetic to prevent intravascular injection, which could lead to systemic toxicity.
Maintain Continuous Visualisation: Ensure that the needle tip remains visible throughout the procedure to avoid complications and ensure accurate deposition of the local anaesthetic.