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Development and evaluation of combined rectus sheath and ilioinguinal blocks for abdominal gynaecological surgery

We describe the development of a technique of combined rectus sheath and ilioinguinal blocks for patients undergoing abdominal gynaecological surgery, and its use in a series of 37 patients (21 midline and 16 transverse incisions). Up to 60 ml of bupivacaine 0.25% with adrenaline 1:400 000 was used, depending on the patient's weight. Median (interquartile range) total morphine requirement (including 0.15 mg.kg−1 given intra‐operatively) up to 48 h after surgery was 0.34 (0.2–0.38) mg.kg−1 for midline incisions and 0.47 (0.35–0.64) mg.kg−1 for transverse incisions; no other systemic opioids were given. Six‐hourly pain scores within the first 48 h after surgery were ≤1 (mild pain) in 11 out of 21 (52%) and ≤2 (moderate pain) in 18 out of 21 (86%) patients with midline incisions and in 5 out of 16 (31%) and 13 out of 16 (81%) patients with transverse incisions, respectively. No patient had emetic symptoms worse than mild nausea during the 48‐h postoperative study period.