Rectus sheath block: behind the muscle, in front of the sheath

Question 1Where does the needle tip sit in a rectus sheath block?

1. aInside the peritoneal cavity
2. bBetween external and internal oblique
3. cBetween rectus abdominis and the posterior rectus sheath
4. dIn the subcutaneous fat over the anterior sheath

Question 2What kind of pain does a rectus sheath block treat?

1. aPain from the lumbar spine
2. bPain from the abdominal wall, not from inside the abdomen
3. cPain from the kidney
4. dPain from the bowel and other abdominal organs

Question 3Why do you block above the arcuate line?

1. aAbove it the block lasts longer
2. bBelow it the posterior sheath ends, leaving only thin fascia over the peritoneum
3. cBelow it the rectus muscle is absent
4. dThe epigastric vessels are only present below it

Question 4Which vessels run on the back of rectus abdominis and need colour Doppler?

1. aThe inferior epigastric vessels
2. bThe femoral vessels
3. cThe internal mammary vessels
4. dThe deep circumflex iliac vessels

Question 5A patient has pain from a midline wound. What do you need?

1. aA block on both sides, with a dose calculation which covers both
2. bNo dose calculation, as the volumes are small
3. cA single injection in the midline
4. dA block on one side only