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 center 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.
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.
