7. Performing Abdominal Blocks Flashcards
most common approach for TAP block
lateral
probe placement lateral TAP
above and parallel to iliac crest
needle insertion TAP
in-plane approach
medial to probe
LA insertion location TAP
TAP plane
- between internal oblique and transversus abdominis
subcostal TAP block location
inferior to costal margin
subcostal TAP indication
upper abdominal incisions
probe placement QL block
between iliac crest and inferior border of ribcage
where the external oblique and lats contact
QL1
lateral QL
LA placement QL1
lateral to the QL muscle
closest to ab muscles
closest to TAP block
QL2
posterior QL
LA placement QL2
between QL and lats
(posterior to QL)
QL3
anterior QL
needle passes through what in QL3
QL muscle
LA placement QL3
between QL and psoas major
which block anesthetizes ventral rami of lower thoracic nerves
QL3
pt positioning QL1
supine
pt position QL2
supine
pt position QL3
lateral
QL muscle looks like
flag from flag pole
which QL block achieves most cephalad spread
QL3
QL volume
30 mL each side
LA placement rectus sheath
between rectus muscle and posterior rectus sheath
what shouldyou avoid during rectus sheath block
inferior and superior epigastric arteries
rectus sheath volume 2 point block
20 mL each side
2 point rectus sheat indication
peri-umbilical surgery
rectus sheath volume 4 point block
20 mL each injection
2 injections per side
4 point rectus sheath indication
midline laparotomy
probe placement rectus sheath
transverse on abdomen
lateral to umbilicus
needle insertion rectus sheath
lateral to medial
rectus sheath needle is deep to
rectus abdominus
rectus sheath needle is superficial to
posterior retus sheath
rectus sheath volume
10 mL each side
LA placement ilioinguinal/iliohypogastric
between internal oblique and transversus abdominis
(TAP plane)
first “pop” ilioinguinal
external oblique
2nd “pop” ilioinguinal
internal oblique
difference between ilioinguinal and TAP location
ilioinguinal is closer to the ilioinguinal/iliohypogastric nerves
does ilioinguinal or TAP require less LA?
ilioinguinal
proble placement ilioinguinal
medial to anterior-superior iliac spine
angled towards umbilicus
abdominal block advantages
- can be performed when neuraxial is CI
- preserves bladder
- preserves motor
- avoids HD instability
- lower risk of neuraxial injury
abdominal block disadvantages
- TAP only somatic
- higher volume
- incr LAST risk
- bilateral block required
what can you hit if you advance needle too dip
bowel
abdominal block complications
- organ damage
- bowel perf
- transient femoral nerve palsy
