Indian J Palliat Care Close
 

Figure 3: Upper row; abdominal muscle DN (a); in the abdominal wall about 7 pairs of needles were placed in rectus abdominis of each side equidistantly between the xiphisternum to the pubis. Three pairs were supraumbilical, 3 pairs were infraumbilical, and 1 pair was on either side of the umbilicus. About 3–4 needles were placed at a distance of 3–4 cm lateral to the needles in rectus abdominis, and another 3–4 needles were placed a further 3–4 cm lateral to the latter to target external and internal oblique muscles, as well as transversus abdominis between the costal margin and the inguinal ligament. The dark stains are betadine used as a medium for USG probe. The costal margin is marked with a blue line. Paravertebral muscle DN (b); the point of insertion was about 1 cm lateral to the spinous process on either side and medial to the facet for the spinalis and multifidi. An out of plane USG was used to visualize the needle tips clearly in the spinalis. The Figures b and e shows the length of the needle “in plane” in the longissimus. Longissimus and iliocostalis part of erector spinae were needled 4–6 cm lateral to the spine below the costal margin. The psoas at L3-5 on either side was visualized to place 3–4 needles in the muscle mass by starting far laterally so that the needle could slip beneath the transverse process (6–8 cm from the spinous process). The muscles targeted by the needles are marked on the figure as follows: S + M – Spinalis + Multifidus, L – longissimus, IC + P – Iliocostalis + Psoas. The costal margin and the iliac crests are also marked, the second row; USGDN: Needles (indicated by N or arrow) are visualized in rectus abdominis (c) EO: External oblique; (d) IO: Internal oblique, TA: Transversus abdominis, ES: Spinalis part of erector spinae, MF: Multifidus, TP: Transverse process; N: Needle in the longissimus (e)

Figure 3: Upper row; abdominal muscle DN (a); in the abdominal wall about 7 pairs of needles were placed in rectus abdominis of each side equidistantly between the xiphisternum to the pubis. Three pairs were supraumbilical, 3 pairs were infraumbilical, and 1 pair was on either side of the umbilicus. About 3–4 needles were placed at a distance of 3–4 cm lateral to the needles in rectus abdominis, and another 3–4 needles were placed a further 3–4 cm lateral to the latter to target external and internal oblique muscles, as well as transversus abdominis between the costal margin and the inguinal ligament. The dark stains are betadine used as a medium for USG probe. The costal margin is marked with a blue line. Paravertebral muscle DN (b); the point of insertion was about 1 cm lateral to the spinous process on either side and medial to the facet for the spinalis and multifidi. An out of plane USG was used to visualize the needle tips clearly in the spinalis. The Figures b and e shows the length of the needle “in plane” in the longissimus. Longissimus and iliocostalis part of erector spinae were needled 4–6 cm lateral to the spine below the costal margin. The psoas at L3-5 on either side was visualized to place 3–4 needles in the muscle mass by starting far laterally so that the needle could slip beneath the transverse process (6–8 cm from the spinous process). The muscles targeted by the needles are marked on the figure as follows: S + M – Spinalis + Multifidus, L – longissimus, IC + <i>P</i> – Iliocostalis + Psoas. The costal margin and the iliac crests are also marked, the second row; USGDN: Needles (indicated by <i>N</i> or arrow) are visualized in rectus abdominis (c) EO: External oblique; (d) IO: Internal oblique, TA: Transversus abdominis, ES: Spinalis part of erector spinae, MF: Multifidus, TP: Transverse process; N: Needle in the longissimus (e)