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      Ultrasound-guided transversus abdominis plane injection with computed tomography correlation: a cadaveric study

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          Abstract

          Background

          Ultrasound-guided transversus abdominis plane (TAP) injections are increasingly being used as an alternative to traditional perioperative analgesia in the abdominal region. With the use of a “blind” TAP block technique, these procedures have had variable success in cadaver and in vivo studies. For more accurate injection with the intended medication, ultrasound guidance allows visualization of the correct layer of the abdominal wall planes in which the thoracolumbar nerves reside.

          Objective

          To assess the spread of various volumes of contrast placed under live ultrasound guidance into the TAP using computed tomography (CT).

          Methods

          Four TAP blocks were performed on 2 fresh frozen cadaver torsos with predetermined contrast volumes of 5, 10, 15, or 20 mL. A CT scan of the cadaver was then performed and interpreted by a musculoskeletal radiologist. This cadaver study was carried out at a tertiary care academic medical center.

          Results

          Cranial–caudal spread of injected contrast correlated with increasing injectate volume and was roughly 1 vertebral level (end plate to end plate) for the 5 mL injection and 2 vertebral levels for the 10, 15, and 20 mL injections. However, the degree of injectate spread may be different for live patients than for cadavers.

          Conclusion

          This study helps further the understanding of injectate spread following ultrasound-guided TAP injections. Specifically, it suggests that 15 mL provides additional cranial–caudal spread and may be an optimal volume of anesthesia.

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          Most cited references 13

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          Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy.

          The transversus abdominis plane (TAP) block is usually performed by landmark-based methods. This prospective, randomized, and double-blinded study was designed to describe a method of ultrasound-guided TAP block and to evaluate the intra- and postoperative analgesic efficacy in patients undergoing laparoscopic cholecystectomy under general anaesthesia with or without TAP block. Forty-two patients undergoing laparoscopic cholecystectomy were randomized to receive standard general anaesthetic either with (Group A, n=21) or without TAP block (Group B, n=21). Ultrasound-guided bilateral TAP block was performed with a high frequent linear ultrasound probe and an in-plane needle guidance technique with 15 ml bupivacaine 5 mg ml(-1) on each side. Intraoperative use of sufentanil and postoperative demand of morphine using a patient-controlled analgesia device were recorded. Ultrasonographic visualization of the relevant anatomy, detection of the shaft and tip of the needle, and the spread of local anaesthetic were possible in all cases where a TAP block was performed. Patients in Group A received significantly less [corrected] intraoperative sufentanil and postoperative morphine compared with those in Group B [mean (SD) 8.6 (3.5) vs 23.0 (4.8) microg, P<0.01, and 10.5 (7.7) vs 22.8 (4.3) mg, P<0.05]. Ultrasonographic guidance enables exact placement of the local anaesthetic for TAP blocks. In patients undergoing laparoscopic cholecystectomy under standard general anaesthetic, ultrasound-guided TAP block substantially reduced the perioperative opioid consumption.
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            Ultrasound-guided transversus abdominis plane (TAP) block.

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              Transversus abdominis plane block: a systematic review.

              Ultrasound guidance has led a surge of interest in transversus abdominis plane (TAP) block for postoperative analgesia following abdominal surgery. Despite or because of the numerous descriptive applications and techniques that have recently populated the literature, results of comparative studies for TAP block have been inconsistent. This systematic review pragmatically addresses many unanswered questions, specifically the following: what are the effects of surgical procedure, block dose, block technique, and block timing on TAP block analgesia? Eighteen intermediate- to good-quality randomized trials that included diverse surgical procedures were identified. Improved analgesia was noted in patients undergoing laparotomy for colorectal surgery, laparoscopic cholecystectomy, and open and laparoscopic appendectomy. There was a trend toward superior analgesic outcomes when 15 mL of local anesthetic or more was used per side compared with lesser volumes. All 5 trials investigating TAP block performed in the triangle of Petit and 7 of 12 trials performed along the midaxillary line demonstrated some analgesic advantages. Eight of 9 trials using preincisional TAP block and 4 of 9 with postincisional block revealed better analgesic outcomes. Although the majority of trials reviewed suggest superior early pain control, we were unable to definitively identify the surgical procedures, dosing, techniques, and timing that provide optimal analgesia following TAP block. This review suggests that our understanding of the TAP block and its role in contemporary practice remains limited.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2013
                01 July 2013
                : 6
                : 493-496
                Affiliations
                [1 ]Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
                [2 ]Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
                [3 ]Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
                Author notes
                Correspondence: Susan M Moeschler, Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA, Email moeschler.susan@ 123456mayo.edu
                Article
                jpr-6-493
                10.2147/JPR.S45913
                3704406
                23861595
                © 2013 Moeschler et al, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

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                Short Report

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