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

Published:September 28, 2019DOI:



      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.


      A total of eight dog cadavers weighing 8.9 ± 1.6 kg.


      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.


      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 cranial–caudal 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 medial–lateral 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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Veterinary Anaesthesia and Analgesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Baldo C.F.
        • Almeida D.
        • Wendt-Hornickle E.
        • Guedes A.
        Transversus abdominis plane block in ponies: a preliminary anatomical study.
        Vet Anaesth Analg. 2018; 45: 392-396
        • Bashandy G.M.N.
        • Elkholy A.H.H.
        Reducing postoperative opioid consumption by adding an ultrasound-guided rectus sheath block to multimodal analgesia for abdominal cancer surgery with midline incision.
        Anesth Pain Med. 2014; 4e18263
        • Bruggink S.M.
        • Schroeder K.M.
        • Baker-Herman T.L.
        • Schroeder C.A.
        Weight based volume of injection influences cranial to caudal spread of local anesthetic solution in ultrasound-guided transversus abdominis plane blocks in canine cadavers.
        Vet Surg. 2012; 41: 455-457
        • Carney J.
        • Finnerty O.
        • Rauf J.
        • et al.
        Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks.
        Anaesthesia. 2011; 66: 1023-1030
        • Castañeda-Herrera F.E.
        • Buriticá-Gaviria E.F.
        • Echeverry-Bonilla D.F.
        Anatomical evaluation of the thoracolumbar nerves related to the transversus abdominis plane block technique in the dog.
        Anat Histol Embryol. 2017; 46: 373-377
        • Chin K.J.
        • McDonnell J.G.
        • Carvalho B.
        • et al.
        Essentials of our current understanding: abdominal wall blocks.
        Reg Anesth Pain Med. 2017; 42: 133-183
        • Dingeman R.S.
        • Barus L.M.
        • Chung H.K.
        • et al.
        Ultrasonography-guided bilateral rectus sheath block vs local anesthetic infiltration after pediatric umbilical hernia repair: a prospective randomized clinical trial.
        JAMA Surg. 2013; 148: 707-713
        • Drozdzynska M.
        • Monticelli P.
        • Neilson D.
        • Viscasillas J.
        Ultrasound-guided subcostal oblique transversus abdominis plane block in canine cadavers.
        Vet Anaesth Analg. 2017; 44: 183-186
        • Evans H.E.
        • de Lahunta A.
        The skeletal and muscular systems.
        in: Evans H.E. de Lahunta A. Guide to the Dissection of the Dog. 8th edn. Elsevier, USA2017: 6-95
        • Fenten M.G.
        • Schoenmakers K.P.W.
        • Heesterbeek P.J.C.
        • et al.
        Effect of local anesthetic concentration, dose and volume on the duration of single-injection ultrasound-guided axillary brachial plexus block with mepivacaine: a randomized controlled trial.
        BMC Anesthesiol. 2015; 15: 130-138
        • Ferguson S.
        • Thomas V.
        • Lewis I.
        The rectus sheath block in paediatric anaesthesia: new indications for an old technique?.
        Paediatr Anaesth. 1996; 6: 463-466
        • Ferreira T.H.
        • Teixeira L.B.C.
        • Schroeder C.A.
        • et al.
        Description of an ultrasound-guided thoracic paravertebral block technique and the spread of dye in dog cadavers.
        Vet Anaesth Analg. 2018; 45: 811-819
        • Ferreira T.H.
        • St James M.
        • Schroeder C.A.
        • et al.
        Description of an ultrasound-guided erector spinae plane block and the spread of dye in dog cadavers.
        Vet Anaesth Analg. 2019; 46: 516-522
        • Flack S.H.
        • Martin L.D.
        • Walker B.J.
        • et al.
        Ultrasound-guided rectus sheath block or wound infiltration in children: a randomized blinded study of analgesia and bupivacaine absorption.
        Paediatr Anaesth. 2014; 24: 968-973
        • Gurnaney H.G.
        • Maxwell L.G.
        • Kraemer F.W.
        • et al.
        Prospective randomized observer-blinded study comparing the analgesic efficacy of ultrasound-guided rectus sheath block and local anaesthetic infiltration for umbilical hernia repair.
        Br J Anaesth. 2011; 107: 790-795
        • Hamill J.K.
        • Liley A.
        • Hill A.G.
        Rectus sheath block for laparoscopic appendicectomy: a randomized clinical trial.
        ANZ J Surg. 2015; 85: 951-956
        • Hamill J.K.
        • Rahiri J.L.
        • Liley A.
        • Hill A.G.
        Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta-analysis of randomized trials.
        Paediatr Anaesth. 2016; 26: 363-371
        • Hermanson J.W.
        • de Lahunta A.
        • Evans H.E.
        The spinal nerves.
        in: Hermanson J.W. de Lahunta A. Evans H.E. Miller and Evans’ Anatomy of the Dog. 5th edn. Elsevier, USA2019: 728-743
        • Hermanson J.W.
        • de Lahunta A.
        • Evans H.E.
        The muscular system.
        in: Hermanson J.W. de Lahunta A. Evans H.E. Miller and Evans’ Anatomy of the Dog. 5th edn. Elsevier, USA2019: 252-258
        • Johnson E.K.
        • Bauquier S.H.
        • Carter J.E.
        • et al.
        Two-point ultrasound-guided transversus abdominis plane injection in canine cadavers – a pilot study.
        Vet Anaesth Analg. 2018; 45: 871-875
        • Manassero A.
        • Bossolasco M.
        • Meineri M.
        • et al.
        Spread patterns and effectiveness for surgery after ultrasound-guided rectus sheath block in adult day-case patients scheduled for umbilical hernia repair.
        J Anaesthesiol Clin Pharmacol. 2015; 31: 349-353
        • Mirra A.
        • von Rotz A.
        • Schmidhalter M.
        • et al.
        Ultrasound-guided lateral and subcostal transversus abdominis plane block in calves: a cadaveric study.
        Vet Anaesth Analg. 2018; 45: 384-391
        • Murouchi T.
        • Iwasaki S.
        • Yamakage M.
        Chronological changes in ropivacaine concentration and analgesic effects between transversus abdominis plane block and rectus sheath block.
        Reg Anesth Pain Med. 2015; 40: 568-571
        • Portela D.
        • Romano M.
        • Briganti A.
        Retrospective clinical evaluation of ultrasound guided transverse abdominis plane block in dogs undergoing mastectomy.
        Vet Anaesth Analg. 2014; 41: 319-324
        • Portela D.A.
        • Campoy L.
        • Otero P.E.
        • et al.
        Ultrasound-guided thoracic paravertebral injection in dogs: a cadaveric study.
        Vet Anaesth Analg. 2017; 44: 636-645
        • Raymond S.A.
        • Steffensen S.C.
        • Gugino L.D.
        • Strichartz G.R.
        The role of length of nerve exposed to local anesthetics in impulse blocking action.
        Anesth Analg. 1989; 68: 563-570
        • Rozen W.M.
        • Tran T.M.N.
        • Ashton M.W.
        • et al.
        Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall.
        Clin Anat. 2008; 21: 325-333
        • Schroeder C.A.
        • Snyder L.B.C.
        • Tearney C.C.
        • et al.
        Ultrasound-guided transversus abdominis plane block in the dog: an anatomical evaluation.
        Vet Anaesth Analg. 2011; 38: 267-271
        • Schleich D.L.
        Schmerzlose Operationen.
        4th edn. Springer, Germany1899: 240-248
        • Skouropoulou D.
        • Lacitignola L.
        • Centonze P.
        • et al.
        Perioperative analgesic effects of an ultrasound-guided transversus abdominis plane block with a mixture of bupivacaine and lidocaine in cats undergoing ovariectomy.
        Vet Anaesth Analg. 2018; 45: 374-383
        • Støving K.
        • Rothe C.
        • Rosenstock C.V.
        • et al.
        Cutaneous sensory block area, muscle-relaxing effect, and block duration of the transversus abdominis plane block: a randomized, blinded, and placebo-controlled study in healthy volunteers.
        Reg Anesth Pain Med. 2016; 40: 355-362
        • Sviggum H.P.
        • Niesen A.D.
        • Sites B.D.
        • Dilger J.A.
        Trunk blocks 101: transversus abdominis plane, ilioinguinal-iliohypogastric, and rectus sheath blocks.
        Int Anesthesiol Clin. 2012; 50: 74-92
        • Ueshima H.
        • Otake H.
        Correspondence: Optimal site for the rectus sheath block.
        J Clin Anesth. 2016; 35: 228-229
        • Yasumura R.
        • Kobayashi Y.
        • Ochiai R.
        A comparison of plasma levobupivacaine concentrations following transversus abdominis plane block and rectus sheath block.
        Anaesthesia. 2016; 71: 544-549