Ultrasound identification of absent rectus abdominis muscle after omphalocele repair altered regional anesthesia strategy in pediatric cardiac surgery: a case report.

Abstract

Background: Previous abdominal wall repair may alter the rectus abdominis muscle structure and render rectus sheath block (RSB) infeasible in pediatric cardiac surgery.

Case presentation: A 5-year-old boy with a history of siloplasty and omphalocele repair underwent right ventricle-to-pulmonary artery conduit replacement. Deep parasternal intercostal plane block and RSB had been planned. However, ultrasound pre-scanning failed to identify the rectus abdominis muscle in the upper abdomen, and the liver was visualized immediately beneath the abdominal wall. Preoperative computed tomography confirmed absence of the rectus abdominis muscle, rendering RSB anatomically infeasible. An alternative upper abdominal wall block was performed. The patient was extubated 2 h after admission to the intensive care unit and had no apparent discomfort from the chest and mediastinal drains.

Conclusions: Preprocedural ultrasound assessment can identify altered rectus abdominis muscle structure and help anesthesiologists select a safer and potentially effective alternative analgesic strategy when RSB is not feasible.