Effective postoperative pain control is vital for

enhanced recovery after abdominal surgeries.

• Rectus sheath block (RSB) provides anterior

abdominal wall analgesia by targeting ventral rami

of spinal nerves (T7-L1).

• Traditional transverse RSB approaches may have

inconsistent dermatomal coverage and catheter

placement challenges.

• This case series introduces a novel longitudinal

RSB technique aimed at improving analgesic

efficacy and coverage.

• Written informed consent was obtained from the

patients for publication of this report.

Case 1

• 57-year-old female patient underwent exploratory

laparotomy, adhesiolysis, sarcoma resection, and

hernia repair via vertical midline incision (T6 to

below umbilicus).

• Continuous longitudinal rectus sheath block

placed from cephalad to caudad direction preextubation

with 5-inch ON-Q SilverSoaker

multiport catheter system.

• Post-op analgesia: bupivacaine 0.125% at 8 mLh-1,

acetaminophen, and lidocaine patch; no opioids

• Median pain score 1 [0–2] over 3 days; sensory

block extended to T12, beyond incision.

• Continuous longitudinal rectus sheath block offers

consistent dermatomal coverage with wider spread of

local anesthetic infusion for vertical abdominal

incisions.

• In this case series, both the patients had low pain

scores, minimal opioid use, and sensory blockade

extending to T12 dermatome.

• Compared to traditional approach, a longitudinally

placed multiport catheter travels through the

anatomical tendinous intersections ensuring local

anesthetic spread along the length of the muscle to

reliably cover for T9-T12 nerves

• Results suggest promise for this technique in

multimodal pain management, warranting further

study in larger cohorts.

 

Case 2

• 32-year-old female patient underwent radical nephrectomy, retroperitoneal lymph node

dissection and mass excision via vertical incision.

• Continuous longitudinal in plane rectus sheath catheters placed in cephalad to caudad direction

using 5-inch ON-Q SilverSoaker multiport catheter system before extubation.

• Postoperatively, received bupivacaine 0.125% at 8 mLh-1, acetaminophen, diclofenac, lidocaine

patch, and one time five mg oxycodone.

• Reported median pain score 2 [0–5] over 3 days; sensory block extended to T12.