Tran T M N, Ivanusic J J, Hebbard P, Barrington M J
Department of Anaesthesia, St Vincent's Hospital, Melbourne, PO Box 2900, Fitzroy, VIC 3065, Australia.
Br J Anaesth. 2009 Jan;102(1):123-7. doi: 10.1093/bja/aen344.
The transversus abdominis plane (TAP) block is a new regional anaesthesia technique that provides analgesia after abdominal surgery. It involves injection of local anaesthetic into the plane between the transversus abdominis and the internal oblique muscles. The TAP block can be performed using a landmark technique through the lumbar triangle or with ultrasound guidance. The goal of this anatomical study with dye injection into the TAP and subsequent cadaver dissections was to establish the likely spread of local anaesthesia in vivo and the segmental nerve involvement resulting from ultrasound-guided TAP block.
An ultrasound-guided injection of aniline dye into the TAP was performed for each hemi-abdominal wall of 10 unembalmed human cadavers and this was followed by dissection to determine the extent of dye spread and nerve involvement in the dye injection.
After excluding one pilot specimen and one with advanced tissue decomposition, 16 hemi-abdominal walls were successfully injected and dissected. The lower thoracic nerves (T10-T12) and first lumbar nerve (L1) were found emerging from posterior to anterior between the costal margin and the iliac crest. Segmental nerves T10, T11, T12, and L1 were involved in the dye in 50%, 100%, 100%, and 93% of cases, respectively.
This anatomical study shows that an ultrasound-guided TAP injection cephalad to the iliac crest is likely to involve the T10-L1 nerve roots, and implies that the technique may be limited to use in lower abdominal surgery.
腹横肌平面（TAP）阻滞是一种新型区域麻醉技术，可在腹部手术后提供镇痛。它涉及将局部麻醉剂注射到腹横肌和腹内斜肌之间的平面。TAP阻滞可通过经腰三角的体表定位技术或在超声引导下进行。本项解剖学研究通过向TAP注射染料并随后进行尸体解剖，旨在确定局部麻醉剂在体内可能的扩散范围以及超声引导下TAP阻滞导致的节段性神经受累情况。
对10具未防腐处理的人体尸体的每侧半腹壁进行超声引导下向TAP注射苯胺染料，随后进行解剖以确定染料扩散范围和染料注射所致的神经受累情况。
排除1个预试验标本和1个组织高度分解的标本后，成功注射并解剖了16侧半腹壁。发现胸下神经（T10 - T12）和第一腰神经（L1）从肋缘和髂嵴之间由后向前穿出。T10、T11、T12和L1节段神经分别在50%、100%、100%和93%的病例中被染料累及。
本解剖学研究表明，在髂嵴上方进行超声引导下的TAP注射可能累及T10 - L1神经根，这意味着该技术可能仅限于在下腹部手术中使用。
