Infiltration Technique Descriptions
Vertical Midline Incision Infiltration Technique
Insert the needle into the dermis and subcutaneous tissue 1-2 cm below the inferior end of the incision parallel to the wound edge and advance it 1-2 cm lateral to the wound edge until it reaches 1-2 cm above the superior end. After confirming no blood with aspiration, infiltrate local analgesic while extracting the needle.
Repeat this step on the other side of the incision, infiltrating the entire length of the incision on both sides (see Figure 5). It is important to infiltrate 1-2 cm beyond the edges of the incision.
2) Deep tissue infiltration:
Under direct visualization, insert the needle at a 30-degree angle along the plane and through the anterior abdominal fascia and subfascia. Needle placement should be deep inside the wound at the level of the abdominal wall fascia and muscle. The goal is to infiltrate lateral to the fascial sutures. Needle should be advanced at a slight angle toward the preperitoneal space. Using a fanning technique and confirming no blood with aspiration, infiltrate 2-4 cc local analgesic 2-3 cm beyond the fascial edge while withdrawing the needle. Under direct visualization, pay special attention to placing local analgesic deep to the anterior abdominal fascia/into the subfascial plane.
Repeat this step by inserting the needle along the lateral borders of the incision until the entire length of both sides of the incision and the superior and inferior ends are infiltrated.
TOTAL: 40-50 cc
Anterior abdominal wall muscle and fascia
30 cc
Infiltration Target
1) Infiltration of dermis and subcutaneous tissue at incision:
Dermis and subcutaneous tissue
(~4 cc/cm) 10-20 cc
Local Analgesic Volume
8
