Test 2 Flashcards
subcostal block blocks which dermatomes
T7-T11
TAP blocks block which dermatomes
T10-L1
Ilioinguinal iliohypogastric blocks which dermatomes
L1
Structures composing Petit’s Triangle
Rib cage
Latissimus dorsi
External oblique
Pelvis
TAP blocks provides which type of relief
Somatic but no visceral analgesic relief
LA for TAP block
30-40ml per side
0.3-0.6 mg/kg
Dilute concentrations down to at least 0.25% bupivacaine or 0.3% Ropivacaine
Indications for TAP block
C section
Appy
Inguinal Hernia Repsir
LA only approved for TAP blocks by FDA
Exparel
20ml diluted in NS
Consideration with TAP block as possible complication/inadvertent
Femoral nerve block
Femoral nerve block with TAP block is due to
Unexpected injection into the transversalis fascia
Transversalis fascia is continuous plane with fascia iliaca
Caution with ambulation
Landmarks for mid axillary TAP block
Subcostal margin
Iliac crest
Muscles involved in TAP block and order from superficial to deep
External oblique
Internal oblique
Transversus abdominis
Where inject LA for TAP block
Between internal oblique and transversus abdominis
US and needling for TAP block
In plane medial to lateral needle approach
If having difficulty Identifying area for injection for TAP what movement with probe
Heel to Toe
**Rocking
To extend TAP block duration
Add epi 1:400,000
Decadron 4 mg per side
Exparel
Problem with Exparel for TAP blocks
Very slow onset
Need to do block preop or early in case
2 tips for improving success of TAP block
Larger volumes (30-40ml)
Be posterior as possible
Subcostal approach for TAP block is beneficial for
Upper abdominal surgeries
Subcostal approach provides analgesia of
T7-T12
Amount of LA for subcostal TAP
20-30ml per side
Muscles identified with subcostal approach
External oblique
Internal oblique
Transversus abdominis
Rectus abdominis
Ilioinguinal/Iliohypogastric block indications
Inguinal hernia repair
Testicular or scrotal surgery
Innervates base of penis only
Iliohypogastric nerve origin
L1
Ilioinguinal nerve origin
L1
Genitofemoral nerve origin
L1-2
Lateral femoral cutaneous nerve origin
L2-3
Subcostal nerve origin
T12
Ilioinguinal-iliohypogastric TAP block landmark approach
2cm medial and then 2 cm cephalad from anterior superior iliac spine (ASIS)
LA amount needle type ilioinguinal/Iliohypogastric block
10ml of LA each injection
- 25-0.5% bupivacaine
- 375-0.5% Ropivacaine
Blunt block needle
Double injection
Ilioinguinal-iliohypogastric provides analgesia to
L1 segment
Near the ilioinguinal iliohypogastric nerve injection area is this structure to be aware of
Deep circumflex iliac artery
For the ilioinguinal-iliohypogastric block should you use doppler? Why?
Yes. Because deep circumflex iliac artery is in the same location
For ilioinguinal-iliohypogastric block injection
2 separate injections
Between EOM and IOM
And between EOM and TAM
