Paraumbilical Block

Patient Position: Supine.

Indications: Intra- and postoperative analgesia for umbilical and paraumbilical hernia repair.

Needle Size: A short beveled needle.

Volume: 0.2 mL/kg of ropivacaine 0.2% for children up to 7 years, levobupivacaine 0.5% for older children.

Anatomic Landmarks: Umbilicus, rectus abdominis muscles (Fig. 53-1).

Approach and Technique:
The external layer of the rectus sheath on both sides of the abdomen is
marked. A short beveled needle is then introduced at the crossing of
the outer border of this muscle with the horizontal line passing over
the umbilicus. The needle is introduced and advanced at a 60° angle to
the skin in the direction of the umbilicus until there is a loss
resistance, corresponding to the piercing of the rectus sheath. This
piercing is clearly identified by a “pop” because the sheath is rather
resistant. After the injection of the volume of local anesthetic the
same technique is repeated on the other side.