Transabdominal Plane Block

Excerpt

Regional anesthesia for abdominal wall procedures can be performed using a variety of peripheral nerve blocks. These blocks are typically ultrasound (US) guided and involve injecting a local anesthetic (LA) solution into interfascial planes. US-guided transversus abdominis plane (TAP) block involves the injection of LA in between the transversus abdominis (TA) and internal oblique (IO) muscles. The TAP block can also be targeted using anatomical landmarks at the level of the Petit triangle. This interfascial plane contains the intercostal, subcostal, iliohypogastric, and ilioinguinal nerves. These nerves give sensation to the anterior and lateral abdominal wall and the parietal peritoneum, providing only somatic and not visceral analgesia.

The TAP block can be used for postoperative analgesia management in open and laparoscopic abdominal surgeries and inpatient and outpatient surgical procedures. Unilateral left- or right-sided blocks are used for unilateral surgical procedures, such as cholecystectomy, appendectomy, nephrectomy, or renal transplants. In contrast, bilateral TAP blocks are used for midline and transverse abdominal incisions, such as umbilical or ventral hernia repair, cesarean deliveries, hysterectomy, and prostatectomy. TAP blocks are part of multimodal pain management for abdominal surgeries, which adds analgesic benefit to patients, reducing postoperative opioid requirements. TAP blocks are typically placed intraoperatively, either before the surgical incision or at the end of the procedure before emergence from anesthesia. The TAP block's efficacy depends on the spread of LA across the interfacial plane. Newer tissue plane blocks, like the quadratus lumborum block, provide somatic and visceral analgesia.

The TAP block has become one of the most common truncal blocks performed for postoperative analgesia after abdominal surgeries. This activity reviews the anatomy of the abdominal wall, the history of the TAP block, classification, approaches, techniques, and complications for this block. It also highlights the indications, contraindications, clinical significance, and materials to perform this block safely.

Conflict of interest statement

Disclosure: Ana Mavarez declares no relevant financial relationships with ineligible companies.

Disclosure: Joseph Maxwell Hendrix declares no relevant financial relationships with ineligible companies.

Disclosure: Andaleeb Ahmed declares no relevant financial relationships with ineligible companies.

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