Ultrasound-guided rectus sheath block: an anatomic study in dog cadavers

Objectives To describe the ultrasound-guided rectus sheath block technique and the anatomical spread of two volumes of methylene blue injection in dog cadavers. Study design Blinded, prospective, experimental cadaveric study. Animals A total of eight dog cadavers weighing 8.9 +/- 1.6 kg. Methods Ultrasound-guided rectus sheath injections were performed bilaterally 1 cm cranial to the umbilicus using 0.25 mL kg(-1) (low volume; LV) and 0.50 mL kg(-1) (high volume; HV) of 0.5% methylene blue dye. A total of 16 hemiabdomens were injected. The ultrasound image quality of the muscular and fascial plane landmarks and needle visualization were scored using a standardized scale. Cadavers were dissected to determine the distribution of the dye and to assess staining of ventral branches of the spinal nerves. Results Fewer ventral spinal nerve branches were stained in the LV group than in the HV group, at 2.00 +/- 0 and 2.90 +/- 0.83, respectively (p < 0.01). Ventral branches of thoracic (T) and lumbar (L) spinal nerves (T10, T11, T12, T13 and L1) were stained 25%, 100%, 75%, 25% and 0% of the time in LV group and 12.5%, 87.5%, 100.0%, 75.0% and 13.0% in HV group. A lesser extent of cranialecaudal dye distribution was observed in the LV group than in the HV group (7.1 +/- 1.8 cm and 9.2 +/- 1.8 cm, respectively; p = 0.03). There was no significant difference in medialelateral spread of dye, number of test doses or ultrasound image quality scores between groups. Conclusions and clinical relevance The results of this study suggest that, on an anatomical basis, this easily performed block has the potential to provide effective abdominal wall analgesia for the ventral midline. This study supports the potential of the rectus sheath block for abdominal procedures, and further investigations on its clinical efficacy are warranted.