Over 127 peer reviewed studies show significant benefits from abdominal wall blocks.
67% reduction in post-op opiate use vs local infiltration 5
Over 70% of patients report being pain free at 1 hour after laparoscopic surgery 6
Abdominal blocks tripled the time to first rescue analgesia 7
Patients were discharged significantly earlier 8
Rectus Sheath Blocks can provide sufficient pain control without the need for any other post-op analgesia 1
Why isn’t every surgeon doing an abdominal wall nerve block?
Ultrasound guidance is impractical. It requires extra equipment, adds extra costs and can delay surgery by over 18 minutes. 9
Blind Loss of Resistance techniques such as the “Pop-Pop” are inaccurate
Local anesthesia is delivered to the correct plane only 14-24% of the time, and 18% of injections believed to be in the correct plane were actually intraperitoneal. 10
Pain free laparoscopy is possible with targeted nerve blocks 15
LARGE VARIATION in the distance from skin to the pre-peritoneal nerve plane
The thickness of abdominal wall fat and muscle at the umbilicus varies by over 50mm. 4 Current methods for targeting the posterior rectus sheath are inefficient and dangerous, because they approach the nerves from the anterior wall. The wide variation in fat and muscle thickness make blind injections highly inaccurate.
LITTLE VARIATION in the distance from peritoneum to the pre-peritoneal nerve plane
The distance from the peritoneum to the deep nerve plane varies by only 4mm. 3 When measured from below, the extreme variation due to fat and muscle thickness is eliminated and the nerve plane can be consistently targeted.
M-CLOSE uses a patented reference plane system, which positions the Nerve Block Needle relative to the peritoneum, not the skin surface.
M-CLOSE KIT combines targeted anesthesia delivery with the most advanced port closure device 11
M-CLOSE PROVIDES A GOLD STANDARD CLOSURE 11
Adheres to the Jonsson-Israelsson rules of fascial closure
Suture bites are symmetrical and 1cm from each side of the defect
Knot is above the fascial plane
M-CLOSE IS EASY
<30 seconds to place the suture
Deploys two needles at once
Can place multiple sutures for large defects
M-CLOSE IS SAFE
No exposed needles help prevent sharps injuries
Shielded needles can help prevent injury to intra-abdominal
organs, even without pneumoperitoneum, or direct visualization 13
M-CLOSE KIT SAVES MONEY
Costs less than most port closure devices
Reduce costs related to post-op port site complications
Save O.R. time by closing ports faster and avoiding unnecessary scope exchanges
Deliver targeted anesthesia at no extra cost
M-CLOSE KIT is designed for OBESE PATIENTS
Current devices use the skin as a reference, resulting in large suture bites as the abdominal wall gets thicker. These large suture bits increase pain and can loosen over time. M-Close uses the fascia as a reference to produce suture loops that are always the SAME SIZE, regardless of abdominal wall thickness.
Natural movement, angled views, and the inevitable fascial tenting make symmetry difficult with individual needle punctures. M-Close is the ONLY device that simultaneously deploys two opposing needles, ensuring proper 180 degree placement every time.
Based on internal report: Ultrasound Analysis of the Rectus Sheath in 93 subjects. Sept. 2018
Kim, J. Thickness of Rectus Abdominis Muscle and Abdominal Subcutaneous Fat Tissue in Adult Women: Correlation with Age, Pregnancy, Laparotomy, and Body Mass Index. Archives of Plastic Surgery 2012; 39(5)
Crosbie, EJ et al. The surgical rectus sheath block for post-operative analgesia: a modern approach to an established technique. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2012; 160: 196–200
Dingeman, RS et al. Ultrasonography-Guided Bilateral Rectus Sheath Block vs Local Anesthetic Infiltration After Pediatric Umbilical Hernia Repair A Prospective Randomized Clinical Trial. JAMA Surg. 2013 Aug; 148(8): 707-13
Shah, VA et al. Ultrasound guided abdominal field blocks improve postoperative pain relief in cesarean delivery: a prospective randomized controlled study. Anesthesia Pain and Intensive Care. 2017; Vol 21(2): 218-223
Smith, BE et al. Rectus sheath and mesosalpinx block for laparoscopic sterilization. Anesthesia. 1991; 46: 875-877
Chazapis, M et al. Improving the Peri-operative care of Patients by instituting a 'Block Room' for Regional Anaesthesia. BMJ Quality Improvement Reports 2014
McDermott, G et al. Should we stop doing blind transversus abdominis plane blocks? Br J Anesthesia 2012: 108 (3): 499–502
As described in US Patent # 9,451,950 Β2
Working Port-Site Hernias: To Close or Not to Close? Does It Matter in the Obese? Bariatric Times June 7, 2011
Based on internal report: M-Close performance testing, July 2018
Owens, M. A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surgeon 2011 Aug; 9(4): 218-24.
Smith BE, Suchak M, Siggins D, Challands J. Rectus sheath block for diagnostic laparoscopy. Anaesthesia. 1988;43:947–8.