Pneumoperitoneum Does Not Influence Spread of Local Anesthetics in Midaxillary Approach Transversus Abdominis Plane Block

Abstract

The stretch of the abdominal wall caused by the insufflation of the abdomen does not influence the spread of dye in the abdominal wall. Because of the absence of posterior spread, regardless of the timing of a midaxillary ultrasound-guided approach, we believe that a posterior approach should be chosen if posterior spread is desired.

Dexmedetomidine added to ropivacaine for transversus abdominis plane block inhibits stress response in laparoscopic surgery: a randomized controlled trial

“…Meta-analysis of randomized controlled trials showed that TAP block is an effective approach to attenuate postoperative pain and decrease the use of opioid after laparoscopic surgery [15,30]. A cadaver study showed that the spread of local anesthetics is not restrained by pneumoperitoneum in midaxillary technique transversus abdominis plane block [31]. DEX was found to provide analgesic effects through supraspinal, ganglionic, spinal, and peripheral actions when it is intraveously administered [22], and to reduce the consumption of opioids during the surgery.…”

Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques

“…Since the lateral cutaneous branches leave the TAP posterior to the midaxillary line, posterior injection of local anesthetics is suggested if analgesia for both the anterior and lateral abdominal wall is required [ 26 ]. However, most of the lateral cutaneous branches arise before the main nerves enter the TAP, and only those of T11 and T12 have a short course within or through the TAP [ 15 ].…”

“…A midaxillary or lateral TAP block is performed by placing the probe at or anterior to the midaxillary line between the costal margin and iliac crest. It can provide lower abdominal wall analgesia from the midline to the midclavicular line [ 10 , 26 ]. Compared to a lateral TAP block, a posterior TAP block approximates the double-pop TAP technique at the lumbar triangle of Petit [ 44 ] by injecting local anesthetic superficial to the transversus abdominis aponeurosis [ 45 ] and offers better and more prolonged analgesia than the lateral approach [ 10 , 42 ].…”

“…Compared to a lateral TAP block, a posterior TAP block approximates the double-pop TAP technique at the lumbar triangle of Petit [ 44 ] by injecting local anesthetic superficial to the transversus abdominis aponeurosis [ 45 ] and offers better and more prolonged analgesia than the lateral approach [ 10 , 42 ]. While subcostal and lateral TAP injections do not always cover the lateral cutaneous branches of the segmental nerves [ 35 ], the posterior approach deposits the injectate posterior to the midaxillary line and may provide better analgesia to the lateral abdominal wall [ 26 ].…”

TAP-block as a component of multimodal analgesia for postoperative anesthesia in obstetrics and gynecology

“…Перший поперековий нерв розгалужується на клубово-підчеревний і клубово-пахвинний нерви, які іннервують сідничну ділянку позаду шкірних гілок Т 12 , підчеревну ділянку, верхньомедіальну частину стегна і ділянку статевих органів [25]. Враховуючи те, що латеральні шкірні гілки виходять з TAP-простору позаду середньої пахвової лінії, для знеболення і передньої, й латеральної стінок живота необхідно проводити задній TAPблок [26]. Латеральний TAP-блок, проведений по середньоаксилярній лінії, знеболює в основному навколопупкову та підпупкову ділянку [10].…”