Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2025; 13(6): 100673
Published online Feb 26, 2025. doi: 10.12998/wjcc.v13.i6.100673
Enhancing postoperative pain control by surgically-initiated rectus sheath block in abdominal aortic aneurysm open repair: A case report
Kuan-Hua Chen, Ming-Yuan Kang, Yi-Ting Chang, Sheng-Yang Huang, Yung-Szu Wu
Kuan-Hua Chen, Ming-Yuan Kang, Yung-Szu Wu, Center for Cardiovascular Disease, Taichung Veterans General Hospital, Taichung 407219, Taiwan
Yi-Ting Chang, Department of Anesthesiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan
Sheng-Yang Huang, Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan
Sheng-Yang Huang, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
Sheng-Yang Huang, Department of Post-Baccalaureate Medicine, National Chung Hsing University, Taichung 402202, Taiwan
Co-corresponding authors: Sheng-Yang Huang and Yung-Szu Wu.
Author contributions: Chen KH contributed to writing original draft, review and editing, conceptualization, methodology, formal analysis; Kang MY and Chang YT contributed to conceptualization, methodology; Wu YS contributed to writing, review and editing, conceptualization, methodology; Huang SY contributed to writing, review and editing, conceptualization, methodology, funding acquisition, project administration; All authors have read and approved the final manuscript.
Supported by the Taichung Veterans General Hospital, No. TCVGH-1125401B.
Informed consent statement: The patient of this report provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng-Yang Huang, MD, PhD, Assistant Professor, Director, Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Situn District, Taichung 407219, Taiwan. drugholic@vghtc.gov.tw
Received: August 22, 2024
Revised: September 27, 2024
Accepted: November 6, 2024
Published online: February 26, 2025
Processing time: 94 Days and 17.6 Hours
Abstract
BACKGROUND

Abdominal aortic aneurysm (AAA) repair often involves significant postoperative pain, traditionally managed with systemic opioids, which can cause undesirable side effects. This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.

CASE SUMMARY

A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA, which had grown from 3.4 cm to 4.3 cm over 14 months. A rectus sheath block was initiated surgically for postoperative pain control. The patient reported low pain scores and did not require systemic intravenous opioids, enabling early ambulation and discharge on postoperative day seven without complications. By preventing complications of systemic opioids, the method indicating a promising direction for postoperative pain management in major vascular surgeries.

CONCLUSION

Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.

Keywords: Abdominal aortic aneurysm; Postoperative pain management; Rectus sheath block; Surgical anesthesia; Opioid-sparing techniques; Case report

Core Tip: This case report highlights the successful use of a surgically-initiated rectus sheath block for postoperative pain management in a patient undergoing elective abdominal aortic aneurysm repair. The technique provided effective analgesia without the need for systemic opioids, enabling early ambulation and discharge on postoperative day seven. The rectus sheath block offers a promising alternative for pain control in abdominal surgeries, minimizing opioid-related side effects. Further research is needed to validate its safety and efficacy in larger patient cohorts.