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Regional Final > TAP Blocks > Flashcards

TAP Blocks Flashcards

1
Q

What 4 structures compose Petits Triangle

A

ASIS
Intercostal margin
External oblique
Latissimus Dorsi

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2
Q

Indications for Midaxillary/Posterior TAP block

A 
T10-L1 
Unilateral does not cross midline
C sections
Inguinal hernia repairs 
Appendectomies 
Exparel is approved for it as well as interscalene blocks
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3
Q

What type of pain does Midaxillary TAP block help with?

A

Somatic only; no visceral pain

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4
Q

Landmarks for Midaxillary/posterior TAP block?

A

Midline between costal margin and superior iliac crest

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5
Q

What can cause femoral nerve block with Midaxillary/Posterior TAP blocks/

A

Unintentional injection into transversalis fascia which is continuous plane with fascia iliaca

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6
Q

Needling for Midaxillary/Posterior TAP block

A

Needle from anterior–> posterior approach

Go in between internal oblique and transversus abdominis

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7
Q

What lies just underneath the transversus abdominis muscle

A

Transversalis fascia

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8
Q

Things that can improve needle tip visualization in Midaxillary/posterior TAP block

A

Challenging in large patients
Use 18 g touhy needle
Can be VERY deep
Place on ventilator with controlled respirations
Hydrodissect with NS
Rocking helps keep eye on needle because more parallel and improves needle insonization

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9
Q

What can be done to get longer block duration with Midaxillary/Posterior TAP?

A

Can add epi 1:400,000
Decadron 4mg/side can be added
Place catheters when possible
Exparel FDA approved

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10
Q

Why do we want to be as posterior as possible for Posterior/Midaxillary TAP block?

A

To get the lateral cutaneous and anterior cutaneous nerves before they separate

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11
Q

Volume of LA for Midaxillary/Posterior TAP block

A

30-40mL each side; dilute LA to 0.25% bupivicaine or 0.375% ropivicaine

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12
Q

Indications for subcostal TAP block?

A

T7-T12 often spares T12-L1
Beneficial for upper abdominal surgical procedures
Ventral or incisional hernias
Maybe in laprascopic cases but probably not because only gets somatic pain/no visceral pain
Good for surgeries above umbilicus

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13
Q

Volume of LA for subcostal TAP block?

A

20-30mL

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14
Q

What muscle is very thin in older people and why do you have to be cautious?

A

Transversus abdominis is very thin and you can rupture bowel

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15
Q

Needling for Subcostal TAP block?

A

Come in from medial aspect through rectus abdominis muscle and inject between internal oblique and transversus abdominis
Want to be as close to rectus muscle as possible

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16
Q

Complications with Subcostal TAP block

A 
Bowel hematoma
Transient femoral block
Infection 
Last because high volume 20-30 mL each side 
Liver lac on R side 
Hematoma
17
Q

IIndications for Ilioinguinal/Iliohypogastric block

A

Inguinal hernia repair
Testicular or scrotal surgery; only innervates base of penis; dorsal n (branch of the pudenal) innervates the rest of the penis
Targets L1 root (ilioinguinal/iliohypogastric)
L1 and L2 form genitofemoral n

18
Q

Where is the best place to target L1 nerve

A

Posterior aspect because catch the lateral cutaneous branch before it exits

19
Q

Landmark approach for Ilioinguinal/iliohypogastric

A

ASIS 2 cm medial and 2 cm superior; use blunt needle to feel piercing of planes
Loss of resistance technique through fascia layer
10mL in between transverse abdominis and internal oblique muscle

20
Q

Indications for Rectus Sheath Block

A

T7-T11
Ventral/incisional hernias
Exploratory lap
Anything within 6 pack region

21
Q

What is the arcurate line?

A

Where rectus sheath thins out and all muscles; internal, external and transversus come together
Ends at T12
Make sure to do block above arcurate line b/c less chance of puncturing bowel

22
Q

Needle placement for rectus sheath

A

Anterior cutaneous nerves exit on lateral aspect of rectus sheath come in from lateral aspect of rectus muscle

23
Q

Where is LA placed in rectus sheath block?

A

Between the rectus muscle and posterior rectus sheath

24
Q

Why should you apply Doppler before injecting with rectus sheath?

A

The inferior epigastric artery

25
Q

LA for Rectus sheath block

A

15 mL on each side; move probe up and down trajectory to see separation of rectus muscle

26
Q

Why is it better to place catheters instead of single shot blocks for TAP blocks?

A

Block duration is very variable; best way to extend block is to place catheter; could not place catheter in iliohypogastric/ilioinguinal b/c very defined; small area

27
Q

Which blocks on UE and TAP can catheters be placed and volume if known?

A

Interscalene 4-6mL/hr
Infraclavicular unknown amount
Midaxillary TAP 0.3-0.6mL/kg or 30-40mL Q 6-8 hours
Subcostal TAP 20-30 mL Q 6-8 hours
Rectus Sheath TAP block 15-20 mL Q 6-8 hours

28
Q

When is the best time to put in Rectus sheath blocks?

A

Post op because will get in the way during surgery

29
Q

Indications for Transversalis Plane Block

A 
Iliac crest bone grafting
Inguinal hernia repair
Hydrocele or testicular surgery
Open apple 
Cecostomy
30
Q

Why is the Transversalis Plane block superior over iliohypogastric/ilioinguinal block?

A

It consistently blocks T12 L1

Reliably blocks both ilioinguinal/iliohypogastric

31
Q

Volume and LA of Transversalis Plane block?

A

20 mL of 0.25% bupivicaine

32
Q

Where is the LA placed in the Transversalis Plane block?

A

Between transversus abdominis and the transversalis fascia which runs continuously with the fascia iliaca

33
Q

Needling for Transversalis plane block

A

From anterior approach; get very close to bowel because go under transversus abdominis

34
Q

Position for Transversalis plane block?

A

Lateral, put probe right above iliac crest

35
Q

Complications with ALL abdominal blocks

A 
Transient femoral nerve block- planes flow together where lumbar plexus located; leads to post op falls
Bowel/hematoma perforation 
Infection (catheters) 
Hematoma 
Liver lacerations
LAST= most common because high volume

Regional Final (3 decks)

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