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Figure 42.1-1.
Graphic Jump LocationGraphic Jump LocationGraphic Jump LocationGraphic Jump Location

(A) Transducer position and needle insertion to accomplish a transverse abdominal plane block. (B) Transducer position and needle insertion to accomplish iliohypogastric and ilioinguinal nerve blocks. (C) Transducer position and needle insertion to accomplish rectus sheath block. (D) Transducer position and needle insertion to accomplish a lateral femoral cutaneous nerve (LFCN) block.

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A - TRANSVERSUS ABDOMINIS PLANE (TAP)

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  • Indications: postoperative analgesia for laparotomy, appendectomy, laparoscopic surgery, abdominoplasty, and cesarean delivery; as an alternative to epidural anesthesia for operations on the abdominal wall
  • Transducer position: transverse on the abdomen, at the anterior axillary line, between the costal margin and the iliac crest
  • Goal: local anesthetic spread between the transversus abdominis and internal oblique muscle planes
  • Local anesthetic: 20-30 mL of 0.25% ropivacaine per side (adults)

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B - Iliohypogastric and Ilioinguinal Nerve

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  • Indications: anesthesia and postoperative analgesia for inguinal hernia repair and other inguinal surgery; analgesia following suprapubic incision
  • Transducer position: oblique on abdomen, on a line joining the anterior superior iliac spine (ASIS) with the umbilicus
  • Goal: local anesthetic spread between the transversus abdominis and internal oblique muscle planes, in the vicinity of the two nerves
  • Local anesthetic: 10 mL per side (adults); 0.15 mL/kg per side (children)

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C - RECTUS SHEATH

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  • Indications: postoperative analgesia for umbilical hernia repair and other umbilical surgery
  • Transducer position: transverse on abdomen, immediately lateral to umbilicus
  • Goal: local anesthetic spread between rectus muscle and posterior rectus sheath
  • Local anesthetic: 10 mL per side (adults); 0.1 mL/kg per side (children)

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D - Lateral Femoral Cutaneous Nerve

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  • Indications: postoperative analgesia for hip surgery, meralgia paresthetica, and muscle biopsy of the proximal lateral thigh
  • Transducer position: transverse, immediately inferior to the anterior superior iliac spine (ASIS); the lateral edge of sartorius (SaM) muscle should be visualized with ultrasound (US)
  • Goal: local anesthetic spread between the tensor fascia latae (TFL) and the sartorius muscle
  • Local anesthetic: 5–10 mL (adults)

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General Considerations

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The ultrasound-guided transversus abdominis plane block, or TAP has become a commonly used regional anesthesia technique for a variety of indications. It is largely devoid of complications and can be performed time-efficiently, either at the beginning or the end of surgery for use as postoperative analgesia. Similar to ilioinguinal and iliohypogastric nerve blocks, the method relies on guiding the needle with ultrasound to the plane between the transversus abdominis and internal oblique muscles, to block the anterior rami of the lower six thoracic nerves (T7-T12) and the first lumbar nerve (L1). Injection of local anesthetic within the ...

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