Best Infiltration Practices App

Local Analgesic Infiltration Techniques for Abdominal Surgery

Best Infiltration Practices - local analgesic techniques for abdominal and orthopedic surgery

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Infiltration Technique Descriptions Pfannenstiel Incision Infiltration Technique A 1.5-inch needle is gently bent as needed or held at an angle that is tangential or as parallel to the dermis as possible. Once the tip of the needle reaches the distal end of the pre-marked site of the incision, the local analgesic is infiltrated while withdrawing the needle. The infiltration is augmented laterally to both the right and left borders of the pre-marked incision by introducing the needle at an angle of 30 degrees in the axial plane, either through the dermis prior to incision or beneath the dermis at the ends of the incision. Infiltrate two fingerbreadths superior and medial to the anterior superior iliac spine deep in the abdominal wall just superficial to the peritoneum, again injecting local analgesic while withdrawing the needle. Take special care to place local analgesic deep to the anterior abdominal fascia/into the subfascial plane utilizing the sensation of a "pop" or "feel" as the needle passes through the different layers of the abdominal wall. 6 & 7) Infiltration of deep fascia: Prior to closure, infiltrate the anterior rectus abdominis fascia bilaterally with local analgesic. Under direct visualization, pay special attention to placing local analgesic deep to the anterior abdominal fascia/into the subfascial plane. Anterior rectus sheath 2-4 cc each 4-8 cc total Infiltration Target Cutaneous nerves (L1 distribution); subcutaneous tissue and anterior abdominal fascia (external oblique muscle fascia and the fusion of internal oblique fascia and transversus abdominis muscle) 2 & 3) Infiltration lateral to dermis incision ends: Subcutaneous and intermuscular layers between external and internal oblique and between internal oblique and transversus abdominis 4 & 5) Infiltration of iliohypogastric nerves: Iliohypogastric nerves 5 cc each 10 cc total 2 cc each 4 cc total Local Analgesic Volume 1) Infiltration of dermis and subcutaneous tissue at incision (or at closure): 6 cc TOTAL: 24-28 cc 2

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