Exam 2 Flashcards by Megan Manasco

3 categories of anterior abdominal wall blocks

TAP block
Posterior and subcostal
Rectus Sheath Block
Inguinal Block

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2 anterior abdominal blocks not located in TAP plane

Rectus Sheath Block

Transversalis Fascial Plane

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External ribs attachment points and direction

Ribs and ASIS

Rung longitudinally (lateral to midline)

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Internal oblique attachment points and direction

Iliac crest and lower part of rib margin

Run midline lateral (opposite of externals)

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Transversus abdominus direction

Horizontally

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TAP blocks are placed between

Internal Oblique (IOM)

And

Transversus Abdominis (TAM)

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TAP blocks block which type of pain

Somatic pain

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Anterior cutaneous branches of intercostal nerve origin

T7-T11

Deep

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Anterior cutaneous branch of subcostal nerve origin

T12

Deep

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Ilioinguinal nerve origin

Deep

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Anterior branch of iliohypogastric nerve origin

Deep

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Lateral cutaneous branches of intercostal nerve origin

T7-T11

Superficial

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Anterior cutaneous branch of subcostal nerve origin

T12

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Which nerve provides sensory portion of center of abdominal at very superficial level

Anterior cutaneous branch of subcostal

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2 branches of genitofemoral nerve

Femoral branch

Genital branch

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Subcostal TAP block blocks which dermatomes

T7-T11

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TAP block blocks which dermatomes

T10-L1

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Ilioinguinal-hypogastric blocks which dermatomes

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Subcostal TAP block targets

Upper abdomen

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Midaxillary/posterior TAP block covers

Lower abdomen

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Ilioinguinal-iliohypogastric block targets

Deep groin area

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Components of Petit’s Triangle

Rib Cage
Latissimus Dorsi
External Oblique
Pelvis

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For posterior TAP block you are targeting

Intercostal nerves running between transversus abdominis and internal oblique muscles

Posterior TAP block you block at __________ targeting

Posterior location and blocks lateral and anterior cutaneous branch

TAP block blocks which dermatomes

T10-L1

TAP blocks are unilateral/bilateral?

Unilateral Does not cross midline

Volume for TAP block

30-40ml per side

Dosage approach for TAP blocks

0.3-0.6ml/kh

Concentration for TAP blocks

Dilute so get volume needed 0. 25% Bupivacaine 0. 3% Ropivacaine

Indications for Subcostal TAP block

surgery below the umbilicus

Unexpected injection into transversalis fascia results in Why?

Femoral Nerve block Bc transversalis fascia is continuous with lumbar plexus

Midaxillary TAP block landmarks

Costal margin Superior Iliac Crest

With midaxillary TAP you want ______ spread Why?

Posterior spread Nerves exit/branch earlier

Inadvertent muscle injection of LA can result in

Myotoxicity- nerve necrosis Most common with Bupivacaine

Method of improving needle isonization

Heel-to-toe (rocking) to get ultrasound beam parallel to needle

To get longer block location with TAP block

Add epi 1:400,000 Add Decadron 4 mg/side Exparel Place catheters when possible

2 tips to improve success of blocks

Large volumes (30-40ml) Be posterior as possible

Subcostal approach TAP block provides analgesia of

T7-T12 Upper abdomen

Indications for subcostal TAP block

Upper abdominal surgeries Ventral or incisional hernias

Volume of LA for subcostal TAP

20-30ml per side Reduced volume because smaller plane

If upper abdominal procedure close to midline

Combine subcostal and rectus sheath block

US view of subcostal

Rectus muscle seen medial

Easiest area of TAP block to visualize fascial planes Why?

Subcostal approach Skin thinnest here (even in obese)

Indications for ilioinguinal/iliohypogastric block

Inguinal hernia repair | Testicular or scrotal surgery

Iliohypogastric nerve and ilioinguinal nerve origin

Genitofemoral nerve origin

L1 and L2 root

Why with ilioinguinal/iliohypogastric block do you want to be as posterior as possible

Because lateral branches branch off early and more posterior more likely to hit these

Block that targets L1 the best

Transversalis fascial plane block

LA amount for ilioinguinal/iliohypogastric block

10 ml each injection 2 injections total

Landmark identification for ilioinguinal/iliohypogastric block

ASIS 2cm medial then 2 cm cephalad

ilioinguinal/iliohypogastric block provides analgesia to

L1 segment

ilioinguinal/iliohypogastric block covers

Very low abdomen groin area

US for ilioinguinal/iliohypogastric block

EOM IOM TAM ASIS Use doppler because deep circumflex iliac artery adjacent to ilioinguinal/iliohypogastric nerves

Which block TAP should you use Doppler of US before injection? Why

ilioinguinal/iliohypogastric block Deep circumflex iliac artery adjacent to nerves

LA concentration and volume location for ilioinguinal/iliohypogastric block

20 ml total - 10 ml EOM and IOM - 10 ml IOM and TAM 0. 25%-0.5% Bupivacaine 0. 375%-0.5% Ropivacaine