Infiltration of the perforating nerve pedicles of the rectus abdominis muscle. Description of the technique and results following implementation

Abstract

Background: The use of local anesthetics in abdominal wall surgery has shown some benefits, although their use in midline hernias is not yet standardized.
Objective: The aim of this study was to compare postoperative outcomes between patients under- going retromuscular midline incisional hernia repair with versus without infiltration of the rectus ab- dominis perforating nerve pedicles.
Material and methods: We describe a novel technique involving infiltration of the perforating nerve pedicles of the rectus abdominis muscle. We conducted an observational, comparative, retrospective study that included patients who underwent surgery for midline incisional hernias with a defect width between 3 and 7 centimeters between October 2023 and May 2025. These patients were divided into two groups: those who received infiltration (WI group) and those who did not (NI group).
Results: A total of 99 patients were included; 52 (53%) in the WI group and 47 (47%) in the NI group. Patients in the WI group presented a significantly lower requirement for rescue analgesia in the im- mediate postoperative period (WI: 28.8% vs. NI: 53.2%; p = 0.015), a lower number of required rescue doses [WI: 1 (r: 0–1) vs. NI: 2 (r: 0–5); p = 0.004], a lower mean VAS score during the first four posto- perative hours (WI: 1.7 ± 2.1 vs. NI: 4.7 ± 3.1; p < 0.001), and a shorter length of hospital stay (WI: 15.4 hours vs. NI: 21.4 hours; p = 0.03). Postoperative morbidity at 30 days was similar in both groups.
Conclusion: Intraoperative infiltration of the rectus abdominis perforating nerve pedicles during mid- line incisional hernia repair was associated with lower requirement for rescue analgesia in the imme- diate postoperative period and earlier hospital discharge.