Year : 2009 | Volume
| Issue : 1 | Page : 1
Ultrasound guided tap block - Have we found the "Gold Standard"?
College of Medicine, King Saud University, Riyadh, Saudi Arabia
A A El-Dawlatly
College of Medicine, King Saud University, Riyadh
Source of Support: None, Conflict of Interest: None
|Date of Web Publication||18-Jul-2009|
|How to cite this article:|
El-Dawlatly A A. Ultrasound guided tap block - Have we found the "Gold Standard"?. Saudi J Anaesth 2009;3:1
The transversus abdominis plane block (TAP) has been described as an effective regional anesthetic method for various surgical procedures. The TAP block is described as a technique where the local anesthetic is administered between the internal oblique and the transversus abdominis muscles via a superficial landmark between the latissimus dorsi, external oblique abdominal muscles and the iliac crest (triangle of Petit) . In recent times there has been increasing interest in ultrasound guided regional blocks. Ultrasonography offers direct visualization of all anatomical structures, the needle and the pattern of spread of local anesthetic with subsequent increasing margin of safety and optimal block quality. Hebbard described an in-plane ultrasound technique for TAP block where a linear ultrasound probe is positioned subcostal and perpendicular to the abdominal wall and a needle insertion point near the xiphoid process . In a recent study on ultrasound TAP blockade among adults undergoing laparoscopic cholecystectomy under general anesthesia, we used also an in-plane technique and a puncture area between the 12 th rib and the iliac crest. Since 15 mL local anesthetic was administered on both sides, the vertical spread of local anesthetic should cover the area between the iliac crest and the 12 th rib. It was possible with this technique to visualize all relevant anatomical structures, the shaft and the tip of the needle and the spread of local anesthetic between the internal oblique and transversus abdominis muscles. We have also noticed that there was significant decrease of systemic analgesics demand as compared with a standard general anesthetic . Furthermore, in this issue of the Saudi J Anaesthesia, Tobias has published his initial experience with ultrasound TAP block for postoperative pain relief in infants and children. The author found that the TAP block provided effective analgesia following various umbilical and lower abdominal procedures in infants and children . However, as in adults still incomplete data are available on the pharmacokinetic profile of the injected local anesthetic during the TAP block procedure. Thus, an important prerequisite before routine use of the TAP blockade is the knowledge of these data and the optimal volume and concentration of local anesthetic used among adults and pediatrics age groups.
| References|| |
|1.||McDonnell JG, O'Donnell BD, Farrell T et al. Transversus abdominis plane block: a cadaveric and radiological evaluation. Reg Anesth Pain Med 2007;32:399-404. |
|2.||Hebbard P, Fujiwara Y, Shibata Y and Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care 2007;35: 616-7. |
|3.||El-Dawlatly A, Turkistani A, Kettner SC, Marie Machata A, Delvi MB, Thallaj A, Kapral S and Marhofer P. Ultrasound guided transversus abdominis plane block: Description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Brit J Anaesth 2009 (in press). |
|4.||Tobias JD. Preliminary experience with transversus abdominis plane block for postoperative pain relief in infants and children. Saudi J Anaesth 2009;3: 2-6. |