Authors: Sofia Portuondo Quirch, Veronica Abello, Olga Chamberlain, Nicole Lynn Warren, Michael Shalaby
Journal: American Journal of Emergency Medicine, 2024 October 14
Implications:
Ultrasound can be used to both diagnose and guide the treatment of incarcerated hernias in the ED. Performing a bilateral rectus sheath block allows for effective anesthesia of the peritoneal wall, relaxation of the abdominal musculature, and nearly painless hernia reduction. This technique provides an alternative to procedural sedation and may prevent the need for surgery in certain cases.
Background:
Patients presenting to the emergency department (ED) with incarcerated or strangulated ventral hernias often experience significant pain. Hernia reduction, even with procedural sedation, can be extremely painful. When hernias cannot be reduced at the bedside using intravenous opioids or sedation, emergent surgery is usually required, which increases morbidity and mortality risks, particularly for high-risk populations.