Enhancing postoperative pain control by surgically-initiated rectus sheath block in abdominal aortic aneurysm open repair: A case report

Figure 1 Progression of infra-renal abdominal aortic aneurysm: Sequential computed tomography imaging demonstrates the progression of an infra-renal abdominal aortic aneurysm, which increased in size by over 1 cm within approximately a year. A: Pre-operative status; B: Post-operative status 2 months later; C: A follow-up 1 year and 4 months post-operation, respectively.

Figure 2 Emergent total arch replacement and thoracic endovascular aortic repair procedure: Involving a total arch replacement using a 28 mm 4-branch Gelsoft™ graft for reconstruction of the ascending aorta and innominate and left carotid arteries. The procedure included a thoracic endovascular aortic repair with a zone 1 landing using GORE C-TAG devices, fenestration of the left subclavian artery with a VIABAHN stent, and resuspension of the aortic valve. An aortic aneurysm measuring approximately 3.3 cm was noted in the abdominal aorta at the time of operation.

Figure 3 Second operation utilizing Gelsoft™ vascular prosthesis: Surgical intervention involved the use of a Gelsoft™ vascular prosthesis (Y graft, 22 mm-11 mm), ligation of the inferior mesenteric artery, and placement of a surgically-initiated rectus sheath catheter for post-operative pain control. A: The surgical plans; B: A peri-operative photo showing the Y graft; C: A post-operative photo illustrating the effective placement of the rectus sheath block and a patient-controlled analgesia device (arrows).

Figure 4 Rectus sheath block technique: A detailed cross-sectional diagram of the abdominal wall illustrating the technique for rectus sheath block. A: The needle target; B: The transverse section of the anterior abdominal wall depicting needle position and local anesthetic injection; C: The placement of the rectus sheath catheter; D: The catheter-over-needle assembly being inserted in a cephalad-to-caudad direction, with intra-abdominal hand placement to feel for needle advancement.

Figure 5 Follow-up computed tomography scans showing stable condition. This image confirms the absence of progression or complications related to the previously observed abdominal aortic aneurysm and surgical interventions.