Rectus sheath nerve block for analgesia & incarcerated hernia

Am J Emerg Med · Dec 2024

Case Reports

Rectus sheath nerve block for analgesia & incarcerated hernia reduction in the emergency department.

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. ⋯ 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.

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- Sofia Portuondo Quirch, Veronica Abello, Olga Chamberlain, Nicole Lynn Warren, and Michael Shalaby.
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, 4300 Alton Road, Miami Beach, FL 33140, United States of America. Electronic address: sofiportuondo4@gmail.com.
- Am J Emerg Med. 2024 Dec 1; 86: 189.e5189.e8189.e5-189.e8.
BackgroundPatients 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.Case ReportWe 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.ImplicationsUltrasound 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.Copyright © 2024 Elsevier Inc. All rights reserved.

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Rectus sheath nerve block for analgesia & incarcerated hernia reduction in the emergency department.

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