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Inguinal hernia repair (IHR) is one of the most common pediatric surgeries, particularly in early childhood. Postoperative pain from IHR can cause significant psychological and physiological distress in children. This study investigates the efficacy and safety of ultrasound-guided rectus sheath block (RSB) in managing postoperative pain and emergence agitation (EA) in children undergoing single-incision laparoscopic inguinal hernia repair, aiming to improve strategies for postoperative care. This single-blind, prospectively, randomized controlled trial enrolled 90 pediatric patients who were randomly assigned to three groups, they were respectively the bilateral rectus abdominis sheath block group under ultrasound guidance (Group R), Local anesthesia infiltration group (Group L) and blank control group (Group C). Primary outcomes included the incidence of EA. Secondary outcomes comprised pain scores, opioid consumption, and adverse events, and Pediatric Anesthesia Emergence Delirium (PAED) scales at various postoperative time points. EA incidence was significantly reduced in Groups R compared to Group C (RR [95% confidence interval] of 0.083 [0.007,0.019], < 0.05). Extubation time in Group R (RSB) was significantly shorter compared to Group C ( < 0.05). During skin incision, mean arterial pressure (MAP) and heart rate (HR) were lower in Group R than in Groups L and C, with significant differences noted only between Groups R and C ( < 0.05). Postoperative pain scores were significantly reduced in Groups R and L compared to Group C ( < 0.05). Additionally, Group R demonstrated prolonged analgesia and reduced opioid consumption. Ultrasound-guided RSB is a safe and effective technique for postoperative analgesia in pediatric single-incision laparoscopic inguinal hernia repair. It provides superior pain relief, reduces EA incidence, and minimizes opioid use. These findings suggest that RSB may be a valuable adjunct to general anesthesia for this specific procedure.

Background Suprapubic incisional hernias (SIH) are a rare wall defect, whose surgical management is challenging because of limited literature. The proximity of the hernia to bone, vascular, nerve, and urinary structures, and the absence of posterior rectus sheath in this location imply adequate technique of surgical repair. We aimed to describe a cohort of female patients operated on for SIH after gynecological surgery using a homogeneous surgical technique and to report surgical outcomes. Methods The records of all consecutive patients operated on for SIH in a specialized surgical center between January 2009 and January 2015 were retrospectively reviewed. The same open technique was performed, i.e., using a mesh placed inferiorly in the preperitoneal space of Retzius, with large overlap, and fixed on the Cooper’s ligaments, through the muscles superiorly and laterally with strong tension, in a sublay or underlay position. Results The cohort included 71 female patients. SIH were recurrent in 31% of patients and was related to cesarean in 32 patients (45.1%) and to gynecologic surgery in 39 patients (54.9%). The mesh was totally extraperitoneal in 76.1% of patients. The postoperative mortality rate was null. The rate of specific surgical complications was 29.6%. After a median follow-up of 30.3 months, the recurrence rate was 7%. Conclusion The open approach for SIH repair was safe and efficient. Due to the paucity of adequate scientific studies, this reproducible open method could help moving toward a standardization of SIH surgical management.

Background: Regional anesthetic techniques can be used to alleviate postoperative pain in patients undergoing major upper abdominal surgery. Our aim was to evaluate the efficacy of bilateral ultrasound (US)-guided rectus sheath (RS) and transversus abdominis plane (TAP) blocks for better perioperative analgesia. Patients and Methods: It is a prospective, observer-blinded, randomized clinical study. 40 eligible patients undergoing elective liver resection or Whipple procedure were included. All patients received a standardized anesthetic technique. Group 1 (n = 20) received preincisional US-guided bilateral RS and TAP blocks using 20 ml volume of bupivacaine 0.25% for each, and group 2 (n = 20) received local wound infiltration at end of surgery with 40 ml of bupivacaine 0.25%. A standardized postoperative analgesic regimen composed of intravenous paracetamol and a morphine patient-controlled analgesia (PCA). The use of intraoperative fentanyl and recovery room morphine boluses, PCA-administered morphine, pain scores as well as number of patients' experienced postoperative nausea and vomiting in the ward at 6 and 24 h were recorded. Results: Group 1 patients received a significantly lower cumulative intraoperative fentanyl, significantly lesser boluses of morphine in postanesthesia care unit, as well, significantly lower cumulative 24 h postoperative morphine dosage than the group 2 patients. Pain visual analog scale scores were significantly lower at both 6 and 24 h postoperatively in TAP group when compared with the no-TAP group. There were no complications related to the TAP block procedures. No signs or symptoms of local anesthetic systemic toxicity were detected. Conclusion: The combination of bilateral US-guided RS and TAP blocks provides excellent perioperative analgesia for major upper abdominal surgery.

Background: Abdominoplasty is a common aesthetic procedure. The transversus abdominis plane block (TAPB) and rectus sheath block (RSB) have proven efficacy as analgesic modality for abdominal surgeries. This study demonstrates post-abdominoplasty analgesic duration consequent to the three surgically infiltrated local anesthetic techniques: bilateral TAPB, bilateral RSB, and subcutaneous infiltration (SCI) of 0.25% bupivacaine. Methods: In this prospective randomized study, 48 adult patients scheduled for abdominoplasty were randomized into three groups: TAPB group (n = 16), RSB group (n = 16), and SCI group (n = 16) utilizing 40 mL of 0.25% bupivacaine for each block. In both TAPB and RSB groups, the block was performed bilaterally after plication of anterior abdominal wall, while in SCI group, the surgical incisional area was infiltrated before skin closure. Main outcome measures included visual analogue scale (VAS), at rest and during movement; the analgesic duration; and the total required doses of morphine in the first postoperative day. Results: A statistically significant longer analgesia was recorded in the TABP group compared with both the RSB and SCI groups. Statistically significant higher VAS scores in the SCI group 4 hours postoperatively was recorded, both at rest and during movement, compared with both TABP and RSB groups. Significant higher morphine consumption in the SCI group was compared with the other two groups. Conclusions: Among the surgically infiltrated anesthetic techniques for abdominoplasty, bilateral TAPB was associated with longer postoperatively analgesic duration with lower morphine consumption in the first 24 hours compared with RSB and SCI.

Background Thoracic epidural analgesia (TEA) is recommended for post-operative pain relief in patients undergoing major abdominal surgery via a midline incision. However, the effectiveness of TEA is variable with high failure rates reported post-operatively. Common side effects such as low blood pressure and motor block can reduce mobility and hinder recovery, and a number of rare but serious complications can also occur following their use. Rectus sheath catheters (RSC) may provide a novel alternative approach to somatic analgesia without the associated adverse effects of TEA. The aim of this study is to compare the efficacy of both techniques in terms of pain relief, patient experience, post-operative functional recovery, safety and cost-effectiveness. Methods/design This is a single-centre randomised controlled non-blinded trial, which also includes a nested qualitative study. Over a two-year period, 132 patients undergoing major abdominal surgery via a midline incision will be randomised to receive either TEA or RSC for post-operative analgesia. The primary outcome measures pain scores on moving from a supine to a sitting position at 24 hours post wound closure, and the patient experience between groups evaluated through in-depth interviews. Secondary outcomes include pain scores at rest and on movement at other time points, opiate consumption, functional recovery, morbidity and cost-effectiveness. Discussion This will be the first randomised controlled trial comparing thoracic epidurals to ultrasound-guided rectus sheath catheters in adults undergoing elective midline laparotomy. The standardised care provided by an Enhanced Recovery Programme makes this a comparison between two complex pain packages and not simply two analgesic techniques, in order to ascertain if RSC is a viable alternative to TEA. Trial registration Current Controlled Trials ISRCTN81223298 (16 January 2014).

Introduction Rectus sheath hematoma is rare. It can present to physicians in many specialties, but invariably the surgeon is contacted regarding management. It is frequently difficult to diagnose, which can result in delay of treatment or unnecessary surgery. Its incidence is on the rise. Methods We present a series of four cases of rectus sheath hematoma that presented to our hospital within a 5‐month period. A comprehensive up‐to‐date review of the literature was undertaken. Results Our research highlights the diagnostic dilemmas, the spectrum of severity (all three grades are represented), the complications, and the need for interdisciplinary awareness. Conclusions Rectus sheath hematoma is a rare but important entity in the differential diagnosis of abdominal pain. Interdisciplinary awareness of this condition is essential, as it is frequently difficult to diagnose, leading to delay in treatment or unneeded surgery. Grade 3 hematomas can lead to abdominal compartment syndrome and can be fatal.

Introduction: Rectus sheath blocks have been used for decades in the operating room for analgesia following umbilical surgical procedures. We present the first reported case series of a rectus sheath block used in the emergency department (ED) for the reduction of an umbilical hernia. Case Series: Four patients presented to the ED for painful, non-reducible umbilical hernias. An ultrasound-guided bilateral rectus sheath block was used in all four patients with complete pain relief and an easy hernia reduction. Conclusion: Rectus sheath blocks are an excellent addition to a multimodal analgesic regimen in periumbilical pain and painful procedures. This block is easy to perform and implement for pain control in umbilical hernias in an ED setting.

Background Severe abdominal pain caused by a rectus sheath hematoma (RSH) can decrease a patient’s activities of daily living. A case of postoperative RSH for which a continuous rectus sheath block (RSB) was effective is reported. Case presentation A 62-year-old woman who had no previous medical history underwent hysterectomy, total cystectomy, and ileal conduit surgery for bladder cancer under epidural and general anesthesia. She complained of severe abdominal pain 40 min after removal of the epidural catheter on postoperative day (POD) 4. Computed tomography showed an RSH on POD 12. For pain relief, an ultrasound-guided continuous RSB was performed on POD 17. After the block, the numerical rating scale (NRS) score during movement decreased immediately (from 10 to 2 or 3), and she had no further need for oral or intravenous analgesics. She was discharged from the hospital without any complications on POD 28. Conclusions Continuous RSB can be an effective technique for pain relief of postoperative RSH.

The unusual clinical presentation of one patient who had bilateral rectus sheath haematoma was lower abdominal pain with acute urinary retention while the other patient with psoas haematoma complained of right sided flank pain with features of femoral neuropathy. Neurological examination revealed hypoesthesia along L2-L3 dermatome of the thigh and weakness in right-hip flexors (Medical Research Council strength scale 3/5) and in knee extensors (2/5) without any ipsilateral knee reflex. Elderly hosts are subjected to higher risk of infection-related mortality and morbidity and complications like shock, concurrent bacteraemia, coagulation abnormalities, gastrointestinal bleeding and acute renal failure are common in this age group6.

Patients who present to the emergency department (ED) with incarcerated or strangulated ventral hernias are often in significant pain. Furthermore, even with procedural sedation, reduction itself also causes substantial pain. Hernias that cannot be reduced at the bedside with intravenous opioids or procedural sedation will require emergent surgery, which contributes to morbidity and mortality, especially in high-risk populations. We present the case of a 94-year-old man with an incarcerated ventral hernia that was reduced in the ED with the aid of a rectus sheath block, ultimately avoiding the need for emergent surgical intervention. Ultrasound can visualize and diagnose an incarcerated hernia, and a bilateral rectus sheath block can be performed in the ED to anesthetize the peritoneal wall, paralyze abdominal musculature, and achieve nearly painless hernia reduction.