Successful distribution of local anaesthetic
Distribution of Local Anaesthetic: Learn how the anaesthetic should spread within the target area, ensuring comprehensive nerve blockade and optimal analgesia.
Ultrasound-Guided Injection: Discover the importance of using real-time ultrasound to monitor the spread of local anaesthetic, ensuring it remains within the correct fascial plane.
Post-Injection Check: Review the area post-injection to ensure the anaesthetic has been distributed evenly and covers the necessary anatomical region for successful pain management.
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Rectus Sheath Block
Even Spread within the Fascial Plane: The local anaesthetic should spread evenly within the fascial plane between the posterior rectus sheath and the rectus abdominis muscle. This distribution ensures that the anterior cutaneous branches of the lower thoracic nerves (T7-T12) are effectively blocked, providing analgesia to the anterior abdominal wall.
Separation of Muscle and Sheath: On ultrasound, the injection of the local anaesthetic should create a visible separation between the rectus abdominis muscle and the posterior rectus sheath. This separation appears as a hypoechoic (dark) area between the muscle and the sheath, indicating that the local anaesthetic is correctly placed.
Longitudinal Spread: The local anaesthetic should spread longitudinally within the rectus sheath, covering the entire length of the sheath from the point of injection. This ensures that the nerves running through the rectus sheath are adequately anesthetised over a broad area, providing effective pain relief.
Continuous Monitoring: During the injection, continuously monitor the spread of the local anaesthetic on the ultrasound screen. This allows for immediate adjustments if the anaesthetic is not spreading as expected, helping to ensure that the block is effective.
Avoidance of Intramuscular Spread: The local anaesthetic should remain within the fascial plane and should not infiltrate into the rectus abdominis muscle. Intramuscular spread is less effective for nerve blockade and can lead to inadequate analgesia.
Volume of LA: The volume of local anaesthetic used for a Rectus Sheath Block typically ranges from 15 to 20 mL per side, depending on the extent of the surgical site and the patient's body habitus. This volume is usually sufficient to cover the length of the rectus sheath and provide effective analgesia for the anterior abdominal wall. The precise volume may be adjusted based on patient-specific factors and the concentration of the anaesthetic. It's crucial to balance effective coverage with safety, particularly in patients with smaller body frames.
Post-Injection Assessment: After completing the injection, reassess the area with ultrasound to confirm that the local anaesthetic has spread adequately within the fascial plane and that there is no pooling or migration outside the intended area.