EDITORIAL
“Inside-out” transversus abdominis plane block There is increasing interest nowadays in the use of transversus abdominis plane (TAP) block for perioperative analgesia in general and obstetric surgical cases. In a recent study, we reported that ultrasound (US)-guided TAP block for pain relief following laparoscopic cholecystectomy has led to a significant decrease of systemic analgesics demand compared with a standard general anesthetic.[1] The visibility of different anterior wall planes offered by US technology has opted anesthesiologists to use that approach for perioperative analgesia. Although TAP block is considered simple, safe, and effective, there are two reports of significant morbidity resulting from damage to viscera, namely liver trauma, even when using US-guidance.[2,3] In an attempt to avoid visceral injury during TAP block, Owen et al., have described a much simpler technique in which the obstetric surgeon, during open surgery, was able to introduce the TAP block via an intra-abdominal approach, which was technically easier and also obviates the risks associated with the conventional TAP procedure.[4] Owen et al. have reported their series in open surgery; we sought of doing TAP block during laparoscopic surgery with retrograde approach or in other words “inside-out” TAP block approach. Theoretically “inside-out TAP” (internal) approach will avoid any possible visceral or vascular trauma compared with the conventional TAP (external) technique. In our case, TAP block was performed under US-guidance with a SonoSite M-Turbo transportable US device (SonoSiteTM Inc., Bothell, WA, USA) and a linear 6-13 MHz US transducer. The edge of the probe was covered by a sterile plastic transducer sheath (Intercoverw, Microtek Medical, USA) and a sterile gel (Asept Inmed, Quint Fonsegrives, France) was applied on the skin. Once the abdominal wall muscles were visualized at the level of the anterior axillary line between the 12th rib and the iliac crest then, the surgeon introduced a 50-mm, 19-gauge needle (Nanoline; Pajunk, Geisingen, Germany) through one of the laparoscopic ports [Figure 1]. Once the tip of the needle was placed within the TAP, negative aspiration was performed followed by injection of 15 mL bupivacaine 5 mg/mL with local anesthetic spread appeared on the US
screen [Figure 2]. Following needle insertion a 21-gauge catheter was introduced through the needle and fixed to the abdominal wall for continuous TAP block [Figure 3].
Figure 1: Needle insertion
Figure 2: Spread of local anesthetic in the transversus abdominis plane
Access this article online Quick Response Code:
Website: www.saudija.org
DOI: 10.4103/1658-354X.136414
Figure 3: Catheter insertion
Saudi Journal of Anesthesia
Vol. 8, Issue 3, July-September 2014
Page | 315
El-Dawlatly and Al-Dohayan: “Inside-out” TAP block Page | 316
We have described this novel approach of “inside-out” TAP (internal) technique which we think it’s safer than the conventional TAP (external) approach for laparoscopic surgery in terms of avoiding visceral or vascular trauma. Furthermore, we believe that continuous “inside-out” TAP block (internal) approach is feasible and may provide more asepsis than the classic TAP (external) approach. Further studies are required to attest our novel approach “inside-out” TAP block. Abdelazeem El-Dawlatly, Abdullah Al-Dohayan1 Departments of Anesthesia and 1Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia Address for correspondence: Prof. Abdelazeem El-Dawlatly, College of Medicine, King Saud University, Riyadh, Saudi Arabia. E-mail: dawlatly@ksu,edu.sa
Vol. 8, Issue 3, July-September 2014
REFERENCES 1.
2. 3. 4.
El-Dawlatly AA, Turkistani A, Kettner SC, Machata AM, Delvi MB, Thallaj A et al. Ultrasound-guided transversus abdominis plane block: Description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth 2009;102:763-7. Lancaster P, Chadwick M. Liver trauma secondary to ultrasound-guided transversus abdominis plane block. Br J Anaesth 2010;104:509-10. Farooq M, Carey M. A case of liver trauma with a blunt regional anesthesia needle while performing transversus abdominis plane block. Reg Anesth Pain Med 2008;33:274-5. Owen DJ, Harrod I, Ford J, Luckas M, Gudimetla V. The surgical transversus abdominis plane block — A novel approach for performing an established technique. BJOG 2011;118:24-7.
How to cite this article: El-Dawlatly A, Al-Dohayan A. “Inside-out” transversus abdominis plane block. Saudi J Anaesth 2014;8:315-6.
Saudi Journal of Anesthesia
Copyright of Saudi Journal of Anaesthesia is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
“Inside-out” transversus abdominis plane block There is increasing interest nowadays in the use of transversus abdominis plane (TAP) block for perioperative analgesia in general and obstetric surgical cases. In a recent study, we reported that ultrasound (US)-guided TAP block for pain relief following laparoscopic cholecystectomy has led to a significant decrease of systemic analgesics demand compared with a standard general anesthetic.[1] The visibility of different anterior wall planes offered by US technology has opted anesthesiologists to use that approach for perioperative analgesia. Although TAP block is considered simple, safe, and effective, there are two reports of significant morbidity resulting from damage to viscera, namely liver trauma, even when using US-guidance.[2,3] In an attempt to avoid visceral injury during TAP block, Owen et al., have described a much simpler technique in which the obstetric surgeon, during open surgery, was able to introduce the TAP block via an intra-abdominal approach, which was technically easier and also obviates the risks associated with the conventional TAP procedure.[4] Owen et al. have reported their series in open surgery; we sought of doing TAP block during laparoscopic surgery with retrograde approach or in other words “inside-out” TAP block approach. Theoretically “inside-out TAP” (internal) approach will avoid any possible visceral or vascular trauma compared with the conventional TAP (external) technique. In our case, TAP block was performed under US-guidance with a SonoSite M-Turbo transportable US device (SonoSiteTM Inc., Bothell, WA, USA) and a linear 6-13 MHz US transducer. The edge of the probe was covered by a sterile plastic transducer sheath (Intercoverw, Microtek Medical, USA) and a sterile gel (Asept Inmed, Quint Fonsegrives, France) was applied on the skin. Once the abdominal wall muscles were visualized at the level of the anterior axillary line between the 12th rib and the iliac crest then, the surgeon introduced a 50-mm, 19-gauge needle (Nanoline; Pajunk, Geisingen, Germany) through one of the laparoscopic ports [Figure 1]. Once the tip of the needle was placed within the TAP, negative aspiration was performed followed by injection of 15 mL bupivacaine 5 mg/mL with local anesthetic spread appeared on the US
screen [Figure 2]. Following needle insertion a 21-gauge catheter was introduced through the needle and fixed to the abdominal wall for continuous TAP block [Figure 3].
Figure 1: Needle insertion
Figure 2: Spread of local anesthetic in the transversus abdominis plane
Access this article online Quick Response Code:
Website: www.saudija.org
DOI: 10.4103/1658-354X.136414
Figure 3: Catheter insertion
Saudi Journal of Anesthesia
Vol. 8, Issue 3, July-September 2014
Page | 315
El-Dawlatly and Al-Dohayan: “Inside-out” TAP block Page | 316
We have described this novel approach of “inside-out” TAP (internal) technique which we think it’s safer than the conventional TAP (external) approach for laparoscopic surgery in terms of avoiding visceral or vascular trauma. Furthermore, we believe that continuous “inside-out” TAP block (internal) approach is feasible and may provide more asepsis than the classic TAP (external) approach. Further studies are required to attest our novel approach “inside-out” TAP block. Abdelazeem El-Dawlatly, Abdullah Al-Dohayan1 Departments of Anesthesia and 1Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia Address for correspondence: Prof. Abdelazeem El-Dawlatly, College of Medicine, King Saud University, Riyadh, Saudi Arabia. E-mail: dawlatly@ksu,edu.sa
Vol. 8, Issue 3, July-September 2014
REFERENCES 1.
2. 3. 4.
El-Dawlatly AA, Turkistani A, Kettner SC, Machata AM, Delvi MB, Thallaj A et al. Ultrasound-guided transversus abdominis plane block: Description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth 2009;102:763-7. Lancaster P, Chadwick M. Liver trauma secondary to ultrasound-guided transversus abdominis plane block. Br J Anaesth 2010;104:509-10. Farooq M, Carey M. A case of liver trauma with a blunt regional anesthesia needle while performing transversus abdominis plane block. Reg Anesth Pain Med 2008;33:274-5. Owen DJ, Harrod I, Ford J, Luckas M, Gudimetla V. The surgical transversus abdominis plane block — A novel approach for performing an established technique. BJOG 2011;118:24-7.
How to cite this article: El-Dawlatly A, Al-Dohayan A. “Inside-out” transversus abdominis plane block. Saudi J Anaesth 2014;8:315-6.
Saudi Journal of Anesthesia
Copyright of Saudi Journal of Anaesthesia is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
