Course of the thoracic nerves around the umbilicus within the posterior layer of the rectus sheath: a cadaver study
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Course of the thoracic nerves around the umbilicus within the posterior layer of the rectus sheath: a cadaver study Akiko Sakai‑Tamura1 · Hiroaki Murata1 · Keiko Ogami‑Takamura1,2 · Kazunobu Saiki2 · Yoshitaka Manabe3 · Toshiyuki Tsurumoto2 · Tetsuya Hara1 Received: 11 July 2020 / Accepted: 3 October 2020 © Japanese Society of Anesthesiologists 2020
Abstract Rectus sheath block is used to anesthetize thoracic nerves around the umbilicus. However, the appropriate point for anesthetic injection during rectus sheath block has not been determined anatomically. Here, we examined the course of thoracic nerve T10 at the posterior layer of the rectus sheath and the anatomical relationship between the nerve and the rectus abdominis and transversus abdominis muscles in formalin-fixed adult cadavers. The cranio-caudal distance from a horizontal line running through the umbilicus to where the thoracic nerve T10 passes through the posterior layer of the rectus sheath was 33.8 ± 14.4 (mean ± standard deviation) mm, while that from the horizontal line running through the umbilicus to the position where the lateral edge of the rectus abdominis muscle and the medial border of the transversus abdominis muscle cross was 33.1 ± 17.1 mm. The position where the lateral edge of the rectus abdominis muscle and the medial border of the transversus abdominis muscle cross approximates the position where thoracic nerves T10 passes through the posterior layer of the rectus sheath. Our results identify effective landmarks to guide the performance of rectus sheath block. Keywords Abdominal muscles · Nerve block · Rectus abdominis · Rectus sheath · Thoracic nerves Branches of the thoracic nerve T10 (T10 nerve) always innervate the umbilicus [1]. The T10 nerve travels the neurovascular plane between the internal oblique and transversus abdominis muscles [1, 2], then passes through the lateral part of the posterior layer of the rectus sheath [1]. After a short course posterior to the rectus abdominis muscle, the T10 nerve penetrates the muscle to supply skin from the midline to the mid-clavicular line [1, 3]. Rectus sheath block (RSB) is used to anesthetize terminal muscular branches and anterior cutaneous branches of thoracic nerves and provides somatic analgesia for surgeries * Hiroaki Murata h‑murata@nagasaki‑u.ac.jp 1
Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1‑7‑1 Sakamoto, Nagasaki 852‑8501, Japan
2
Department of Macroscopic Anatomy, Nagasaki University Graduate School of Biomedical Sciences, 1‑12‑4 Sakamoto, Nagasaki 852‑8523, Japan
3
Department of Oral Anatomy and Dental Anthropology, Nagasaki University Graduate School of Biomedical Sciences, 1‑7‑1 Sakamoto, Nagasaki 852‑8588, Japan
with midline incisions [2, 4, 5]. The efficacy of RSB has been well studied in umbilical hernia repair surgery in children [6, 7]. In addition, the clinical importance of RSB has increased because single-incision laparoscopic surgery, which requir
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