The subcostal nerve as the target for nerve stimulator guided transverse abdominis plane blocks – A feasibility study

Abstract

Background and Aims: Transverse Abdominis Plane (TAP) block was originally described as a landmark-based technique. Peripheral nerve stimulator (PNS) guided blocks are still widely performed, where ultrasound is unavailable. Methods: Cadaveric dissections were performed which showed the subcostal nerve following a predictable course at the lateral abdominal wall in the TAP. The subcostal nerve was identified by ultrasound in three volunteers. Stimulation of the subcostal nerve was performed using PNS and landmarks as guidance in and 20 patients. Twitches of the anterior abdominal wall muscles were elicited, and needle position and drug dispersion were confirmed using ultrasound. Results: Out of 32 attempts made, the drug dispersion was appropriate in 24, not appropriate on four insertions and twitches were not elicited in 4 attempts. Conclusion: Nerve stimulator can be used as a guidance for TAP blocks where the availability of ultrasound is limited.

Cryoneurolysis of the Subcostal Nerve: A Technical Description and Case Report

“…The subcostal nerve, the largest among the thoracic spinal nerves in diameter, travels below the 12th rib, passes behind the kidney, and gives rise to branches, including the lateral cutaneous nerve and the motor branch to pyramidalis [12]. The subcostal nerve, unlike the intercostal nerves, is especially susceptible to injury as it passes beyond the tips of intact ribs that could otherwise shield the nerve from damage.…”

Regional block: Walking away from central to peripheral nerves and planes for local anaesthetic drug deposition

“…This journal has published in the past various original articles and reports pertaining to these newer blocks and their comparisons with older blocks. [234567891011121314] This issue of the journal reports a randomised trial wherein COMBIPECS (combinations of Pecs 1 and Pecs 2) block has been studied for breast surgeries. [15]…”

“…Most of the studies related to fascial plane block are primarily related to the analgesic effect as the primary outcome measure. [2456789101112131415] The majority of the studies report that addition of these newer blocks decreases the requirement of analgesics (specifically opioid) during the perioperative period. The comparative study among individual blocks has reported variable results and the superiority of an individual block has not been determined conclusively.…”

“…Injection of drug in fascial plane may lead to adhesion and may interfere with surgical interventions in future. The newer fascial plane blocks have been reported primarily for analgesia[2456789101112131415] and not as sole anaesthetics. [3] The role of these blocks alone or in combination for effective anaesthesia needs further exploration.…”

The subcostal nerve as the target for nerve stimulator–guided transversus abdominis plane blocks - Commentary

“…have described in their study subcostal nerve stimulation–guided TAP block. [11] The relationship between the subcostal nerve and TAP was established by cadaveric dissections. Following sono-identification of the subcostal nerve in volunteers, the authors have conducted a feasibility study of subcostal nerve stimulation-guided TAP block in patients.…”