Transversus Abdominis Plane Block
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REGIONAL ANESTHESIA (CJ MCCARTNEY, SECTION EDITOR)
Transversus Abdominis Plane Block Aidan Sharkey • Olivia Finnerty • John G. Mc Donnell
Published online: 18 September 2013 Springer Science + Business Media New York 2013
Abstract Regional anaesthesia is a rapidly evolving subspecialty of anaesthesia. Of late, there has been an increasing interest in the use of abdominal plane blocks for post-operative analgesia post-abdominal wall surgery. There are promising data emerging on the efficacy of these blocks. Of particular importance is the transversus abdominis plane (TAP) block, which has proven to be beneficial in reducing post-operative pain scores and opioid consumption when used as part of a multimodal regime in post-operative analgesia. Interest in techniques and applications of the TAP block has expanded exponentially since its introduction over 10 years ago. Clinical trials are continuing to be published examining the role of TAP blocks with various abdominal surgeries, and variants of the TAP block are constantly being conceived to extend the analgesic properties of the block. The choice of techniques and approaches has been assisted by the availability of ultrasound, but the optimal injection sites for different types of surgical incisions remains unclear. The TAP block
A. Sharkey O. Finnerty J. G. Mc Donnell (&) Department of Anesthesia, Clinical Sciences Institute, National University of Ireland, Galway, Ireland e-mail: [email protected] O. Finnerty J. G. Mc Donnell Department of Anesthesia and Intensive Care Medicine, Galway University Hospitals, Galway, Ireland J. G. Mc Donnell Clinical Research Facility, Galway University Hospitals, Galway, Ireland J. G. Mc Donnell The Centre for Pain Research, National University of Ireland, Galway, Ireland
continues to evolve and is becoming pivotal to our daily anaesthetic practice. Keywords Analgesia Anaesthesia Transversus abdominis plane block Regional anaesthesia Abdominal surgery Post-operative Pain
Introduction First described by Rafi [1], the transversus abdominis plane (TAP) block has being the subject of multiple clinical trials to determine its analgesic efficacy in postoperative analgesia. The TAP block has repeatedly been shown to be effective in reducing post-operative pain scores when used as part of a multimodal analgesic regime in both upper and lower abdominal surgery [2•]. The original approach described the insertion of a needle via the lumbar triangle of Petit, using a ‘double pop’ or a ‘loss of resistance’ technique, which resulted in the needle tip being placed within the TAP. It was originally thought that infiltration of local anaesthetic at this point would result in blockade of the somatic nerves supplying the anterior abdominal wall by localized spread, before branching of these nerves throughout the TAP. Our understanding of the TAP block has evolved in recent years thanks to a plethora of studies looking at its effectiveness [2•], spread patterns with various needle insertion points [3–5], and the various c
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