3.21 TAP Block

Question 1

Describe a blind technique for TAP Block

Answer 1

Supine anaesthetised patient

Lumbar triangle of petit - mid ax line
1 Base - Iliac crest
2. Anterior wall - Ex oblique
3. Post wall - Lat dorsi

Question 2

Blind technique procedure

Answer 2

Puncture behind mid axillary line
above iliac crest

Approp blunt needle advance
2 distinct pops:
Needle crosses fascial plans of
Internal oblique and TV Abdominus

Negative aspiration
La slowly injected under minimal resistance
intermittent aspiration

Question 3

US technique

Answer 3

Linear array 6-13 MHz probe
horizontal plane
between costal margin and iliac crest

In plane technique
introduce a blunt needle approx. 3-4 cm lateral to prob

Advance so top lies between int oblique and TV abdominus muscle layers

Negative aspiration

US - discriminate IM and intrafascial injection

Question 4

Indications

Answer 4

Reliable spread LA
T10-L1
Confirmed imaging and cadaver studies

Good analgesia
Lower abdo operation:

Uni
Open appendix
Open hernia

Bilateral

Question 5

Indications Bilateral

Answer 5

Bilateral:

1. Laparoscopic port incisions
2. Pfannenstiel - section
3. Abdo surgery - c/i to Central neuraxial block
4. Literature reports use in prostatectomy - reductions morphine usage

5 Subcostal TAP
upper GI surgeries

Question 6

Limititations

Answer 6

1. Generally a safe area for regional block
2. Needle trauma to local structures
   Nerves blood vessels
   Underlying bowel
3. Liver injury w/ undiagnosed hepatomegaly
4. IV injection
5. Infection
6. Failure
7. Proximal spread LA difficult predict above L1
8. Performed as single shot
   Catheter gaining popularity