RT Book, Section
A1 Elsharkawy, Hesham
A1 Bendtsen, Thomas F.
A2 Hadzic, Admir
SR Print(0)
ID 1141734719
T1 Ultrasound-Guided Transversus Abdominis Plane and Quadratus Lumborum Blocks
T2 Hadzic's Textbook of Regional Anesthesia and Acute Pain Management, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071717595
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1141734719
RD 2024/04/24
AB Ultrasound-guided  transversus  abdominis  plane  (TAP)  block  has  become  a  common  analgesic  method  after  surgery  involving  the  abdominal  wall.  Because  TAP  blockade  is  limited  to  somatic  anesthesia  of  the  abdominal  wall  and  highly  dependent  on  interfascial  spread,  various  newer  techniques  have  been  proposed  to  enhance  analgesia,  either  in  addition  to  TAP  block  or  as  a  single  modality.  In  particular,  variants  of  quadratus  lumborum  blocks  (QLBs)  have  been  proposed  as  more  consistent  methods  with  an  aim  to  accomplish  somatic  as  well  as  visceral  analgesia  of  the  abdomen.  The  present  evidence,  mainly  case  reports,  suggests  that  different  variants  of  QLB  have  different  analgesic  effects  and  mechanisms  of  action,  although  this  has  not  been  formally  validated.  In  particular,  transmuscular  QLB  and  the  so-called  QLB2  may  result  in  wider  and  longer  sensory  blockade  compared  to  TAP  block  (T4–L1  for  QL  block  vs.  T6–T12  for  the  TAP  blocks)  (Figures  34–1  and  34–2).  This  chapter  focuses  on  underlying  principles  for  TAP  blockade  and  the  newer  QLB  techniques,  with  an  understanding  that  the  information  about  the  latter  is  based  on  sparse  evidence  of  limited  quality  as  outcome-based  studies  are  not  yet  available.