Ai Ono, Keisuke Yoshida, Rieko Oishi, Satoki Inoue
{"title":"A case of accidental intraperitoneal placement of the rectus sheath block catheter via an out-of-plane approach","authors":"Ai Ono, Keisuke Yoshida, Rieko Oishi, Satoki Inoue","doi":"10.1186/s40981-024-00705-4","DOIUrl":null,"url":null,"abstract":"<p>To the editor,</p><p>Continuous nerve blocks have become widely used for postoperative analgesia in recent years. Ultrasound-guided catheter insertion is commonly performed using an in-plane or out-of-plane approach [1]. However, it is unclear which approach is more effective. Herein, we report a case in which a catheter for continuous rectus sheath block unexpectedly reached the abdominal cavity, via an out-of-plane approach.</p><p>A 67-year-old woman underwent bilateral rectus sheath blocks with a catheter-through-needle technique (Hakko Disposable Pain Clinic Set®, Hakko, Japan) after open surgical repair of abdominal aortic aneurysm. On ultrasound, due to the surgical wound, the posterior sheath of the rectus abdominis muscle could not be visualized well in the long-axis view with a linear probe; thus, we placed two catheters (left and right sides) under the short-axis view of the rectus sheath muscle using an out-of-plane approach, while injecting a small amount of drug solution to confirm the tips of needle. When we advanced the needle to the proper location, we observed the spread of local anesthetic (0.25% levobupivacaine, 20 mL per one side) along the rectal sheath. Then, we inserted the catheter, rigidly holding the needle in place so it would not shift from its position. However, the tip of the catheter was not clearly visible on ultrasound, and we did not evaluate the spread of local anesthetics administered through the catheter. On the Postoperative Day 1, routine postoperative computed tomography revealed that the right catheter had strayed into the abdominal cavity (Fig. 1). This catheter was quickly removed, resulting in no complications.</p><figure><figcaption><b data-test=\"figure-caption-text\">Fig. 1</b></figcaption><picture><source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs40981-024-00705-4/MediaObjects/40981_2024_705_Fig1_HTML.png?as=webp\" type=\"image/webp\"/><img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"422\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs40981-024-00705-4/MediaObjects/40981_2024_705_Fig1_HTML.png\" width=\"685\"/></picture><p>A computed tomography scan (transverse view) on Postoperative Day 1. The white arrow in the figure indicates the catheter, which strayed into the abdominal cavity</p><span>Full size image</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>The primary advantage of the in-plane approach is its safety, because the entire needle can be visualized during the procedure. The primary disadvantage is its narrow ultrasound beam width of ≤ 1 mm, which makes the visibility of the needle difficult [2]. Furthermore, the distance from the skin to the target tends to be longer using this approach, possibly resulting in reduced visibility in deeper areas [3]. In contrast, the out-of-plane approach has the advantage of good maneuverability of the needle compared to the in-plane approach [2]. However, it has the drawback of not visualizing the entire needle; that is, only a point of the needle is visible, but that point is not necessarily the “true” needle tip [4]. Additionally, the needle we used for the patient in the current report was a non- echogenic needle; thus, the needle tip was difficult to identify. Consequently, this drawback of the out-of-plane approach with this type of needle may have led to the outcome of the present case. In addition, on reflection, we also suspect that inadequate evaluation of the catheter tip position (after the needle was removed) contributed to both the outcome and the delay in detection. If the needle or the target is not clearly visible under ultrasound, the nerve block procedure must be discontinued, and alternative analgesic methods should be used.</p><p>In conclusion, we believe that we should be aware of the advantages and disadvantages of the out-of-plane and in-plane approaches when performing ultrasound-guided catheter insertion for continuous nerve block, and nerve block should not be performed if the location of the needle/catheter cannot be definitively confirmed by ultrasound.</p><p>Not applicable.</p><ol data-track-component=\"outbound reference\"><li data-counter=\"1.\"><p>Rebecca LJ, Sandra LK, Jens K, Andrew TG. Chpter 46: Peripheral Nerve Blocks and Ultrasound Guidance for Regional Anesthesia. In: Michael AG, editors. Miller’s Anesthesia. 9th ed. Elsevier; 2020. p. 1450–1479.</p></li><li data-counter=\"2.\"><p>Griffin J, Nicholls B. Ultrasound in regional anaesthesia. Anaesthesia. 2010;65(Suppl):1–12.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"3.\"><p>Kurdi MS, Agrawal P, Thakkar P, Arora D, Barde SM, Eswaran K. Recent advancements in regional anaesthesia. Indian J Anaesth. 2023;67:63–70.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"4.\"><p>Neice AE, Forton C. Evaluation of a novel out-of-plane needle guide. J Ultrasound Med. 2018;37:543–9.</p><p>Article PubMed Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><p>The authors would like to thank the Scientific English Editing Section of Fukushima Medical University for their work on this manuscript.</p><p>Not applicable.</p><h3>Authors and Affiliations</h3><ol><li><p>Department of Anesthesiology, Fukushima Medical University School of Medicine, 1, Hikariga-Oka, Fukushima, Fukushima, 960-1295, Japan</p><p>Ai Ono, Keisuke Yoshida, Rieko Oishi & Satoki Inoue</p></li></ol><span>Authors</span><ol><li><span>Ai Ono</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Keisuke Yoshida</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Rieko Oishi</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Satoki Inoue</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Contributions</h3><p>AO and KY contributed to the writing of the manuscript. RO and SI helped to draft the manuscript. All authors have read and approved the manuscript.</p><h3>Corresponding author</h3><p>Correspondence to Keisuke Yoshida.</p><h3>Ethics approval and consent to participate</h3>\n<p>In our institution, IRB approval is not required for a case report.</p>\n<h3>Consent for publication</h3>\n<p>Written informed consent for the publication of this article was obtained from the patient.</p>\n<h3>Competing interests</h3>\n<p>The authors declare that they have no competing interests.</p><h3>Publisher’s Note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.</p>\n<p>Reprints and permissions</p><img alt=\"Check for updates. 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0-.92-.08-1.33-.25-.41-.16-.77-.4-1.08-.7-.3-.31-.54-.69-.72-1.13-.17-.44-.26-.95-.26-1.52zm4.61-.62c0-.55-.11-.98-.34-1.28-.23-.31-.58-.47-1.06-.47-.41 0-.77.15-1.08.45-.31.29-.5.73-.57 1.3zm3.01 2.23c.31.24.61.43.92.57.3.13.63.2.98.2.38 0 .65-.08.83-.23s.27-.35.27-.6c0-.14-.05-.26-.13-.37-.08-.1-.2-.2-.34-.28-.14-.09-.29-.16-.47-.23l-.53-.22c-.23-.09-.46-.18-.69-.3-.23-.11-.44-.24-.62-.4s-.33-.35-.45-.55c-.12-.21-.18-.46-.18-.75 0-.61.23-1.1.68-1.49.44-.38 1.06-.57 1.83-.57.48 0 .91.08 1.29.25s.71.36.99.57l-.74.98c-.24-.17-.49-.32-.73-.42-.25-.11-.51-.16-.78-.16-.35 0-.6.07-.76.21-.17.15-.25.33-.25.54 0 .14.04.26.12.36s.18.18.31.26c.14.07.29.14.46.21l.54.19c.23.09.47.18.7.29s.44.24.64.4c.19.16.34.35.46.58.11.23.17.5.17.82 0 .3-.06.58-.17.83-.12.26-.29.48-.51.68-.23.19-.51.34-.84.45-.34.11-.72.17-1.15.17-.48 0-.95-.09-1.41-.27-.46-.19-.86-.41-1.2-.68z" fill="#535353"/></g></svg>\" width=\"57\"/><h3>Cite this article</h3><p>Ono, A., Yoshida, K., Oishi, R. <i>et al.</i> A case of accidental intraperitoneal placement of the rectus sheath block catheter via an out-of-plane approach. <i>JA Clin Rep</i> <b>10</b>, 21 (2024). https://doi.org/10.1186/s40981-024-00705-4</p><p>Download citation<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><ul data-test=\"publication-history\"><li><p>Received<span>: </span><span><time datetime=\"2024-02-19\">19 February 2024</time></span></p></li><li><p>Revised<span>: </span><span><time datetime=\"2024-03-28\">28 March 2024</time></span></p></li><li><p>Accepted<span>: </span><span><time datetime=\"2024-03-30\">30 March 2024</time></span></p></li><li><p>Published<span>: </span><span><time datetime=\"2024-04-03\">03 April 2024</time></span></p></li><li><p>DOI</abbr><span>: </span><span>https://doi.org/10.1186/s40981-024-00705-4</span></p></li></ul><h3>Share this article</h3><p>Anyone you 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Abstract
To the editor,
Continuous nerve blocks have become widely used for postoperative analgesia in recent years. Ultrasound-guided catheter insertion is commonly performed using an in-plane or out-of-plane approach [1]. However, it is unclear which approach is more effective. Herein, we report a case in which a catheter for continuous rectus sheath block unexpectedly reached the abdominal cavity, via an out-of-plane approach.
A 67-year-old woman underwent bilateral rectus sheath blocks with a catheter-through-needle technique (Hakko Disposable Pain Clinic Set®, Hakko, Japan) after open surgical repair of abdominal aortic aneurysm. On ultrasound, due to the surgical wound, the posterior sheath of the rectus abdominis muscle could not be visualized well in the long-axis view with a linear probe; thus, we placed two catheters (left and right sides) under the short-axis view of the rectus sheath muscle using an out-of-plane approach, while injecting a small amount of drug solution to confirm the tips of needle. When we advanced the needle to the proper location, we observed the spread of local anesthetic (0.25% levobupivacaine, 20 mL per one side) along the rectal sheath. Then, we inserted the catheter, rigidly holding the needle in place so it would not shift from its position. However, the tip of the catheter was not clearly visible on ultrasound, and we did not evaluate the spread of local anesthetics administered through the catheter. On the Postoperative Day 1, routine postoperative computed tomography revealed that the right catheter had strayed into the abdominal cavity (Fig. 1). This catheter was quickly removed, resulting in no complications.
The primary advantage of the in-plane approach is its safety, because the entire needle can be visualized during the procedure. The primary disadvantage is its narrow ultrasound beam width of ≤ 1 mm, which makes the visibility of the needle difficult [2]. Furthermore, the distance from the skin to the target tends to be longer using this approach, possibly resulting in reduced visibility in deeper areas [3]. In contrast, the out-of-plane approach has the advantage of good maneuverability of the needle compared to the in-plane approach [2]. However, it has the drawback of not visualizing the entire needle; that is, only a point of the needle is visible, but that point is not necessarily the “true” needle tip [4]. Additionally, the needle we used for the patient in the current report was a non- echogenic needle; thus, the needle tip was difficult to identify. Consequently, this drawback of the out-of-plane approach with this type of needle may have led to the outcome of the present case. In addition, on reflection, we also suspect that inadequate evaluation of the catheter tip position (after the needle was removed) contributed to both the outcome and the delay in detection. If the needle or the target is not clearly visible under ultrasound, the nerve block procedure must be discontinued, and alternative analgesic methods should be used.
In conclusion, we believe that we should be aware of the advantages and disadvantages of the out-of-plane and in-plane approaches when performing ultrasound-guided catheter insertion for continuous nerve block, and nerve block should not be performed if the location of the needle/catheter cannot be definitively confirmed by ultrasound.
Not applicable.
Rebecca LJ, Sandra LK, Jens K, Andrew TG. Chpter 46: Peripheral Nerve Blocks and Ultrasound Guidance for Regional Anesthesia. In: Michael AG, editors. Miller’s Anesthesia. 9th ed. Elsevier; 2020. p. 1450–1479.
Griffin J, Nicholls B. Ultrasound in regional anaesthesia. Anaesthesia. 2010;65(Suppl):1–12.
Article PubMed Google Scholar
Kurdi MS, Agrawal P, Thakkar P, Arora D, Barde SM, Eswaran K. Recent advancements in regional anaesthesia. Indian J Anaesth. 2023;67:63–70.
Article PubMed PubMed Central Google Scholar
Neice AE, Forton C. Evaluation of a novel out-of-plane needle guide. J Ultrasound Med. 2018;37:543–9.
Article PubMed Google Scholar
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The authors would like to thank the Scientific English Editing Section of Fukushima Medical University for their work on this manuscript.
Not applicable.
Authors and Affiliations
Department of Anesthesiology, Fukushima Medical University School of Medicine, 1, Hikariga-Oka, Fukushima, Fukushima, 960-1295, Japan
Ai Ono, Keisuke Yoshida, Rieko Oishi & Satoki Inoue
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Ai OnoView author publications
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AO and KY contributed to the writing of the manuscript. RO and SI helped to draft the manuscript. All authors have read and approved the manuscript.
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Correspondence to Keisuke Yoshida.
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Ono, A., Yoshida, K., Oishi, R. et al. A case of accidental intraperitoneal placement of the rectus sheath block catheter via an out-of-plane approach. JA Clin Rep10, 21 (2024). https://doi.org/10.1186/s40981-024-00705-4
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DOI: https://doi.org/10.1186/s40981-024-00705-4
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