Milan Zoka, Tabor Dominic, McConnell Patricia, Pickering James, Kocarev Mitko, du Feu Frances, Barton Sarah
Department of Anaesthesia, St James's University Hospital, Beckett St, Leeds, United Kingdom.
Med Glas (Zenica). 2011 Aug;8(2):181-4.
The transversus abdominis plane (TAP) block is a new technique for providing analgesia to the anterior abdominal wall. There is ongoing debate regarding access point for TAP block. The aim of this cadaveric study was to compare the spread of 40 mL of dye using three different approaches to TAP: subcostal , via the mid-axillary and via the lumbar triangle of Petit (LTOP).
Injection of black dye into the TAP was performed for each hemi-abdominal wall of 13 embalmed human cadavers by using 3 different access points: subcostal (9 hemi-abdomens), mid-axillary (9) and LTOP (8). This was followed by dissection to determine the extent of dye spread and nerve involvement in the dye injection. The shapes of the dye were traced onto clear plastic, which was then photographed. These digital photographs were loaded into the mathematical software programme Matlab, and the outline of the dye spread was digitised using a piecewise cubic spline, enabling the shapes to be plotted on a graph and the areas to be calculated.
The area of the dye spread for subcostal, mid-axillary and LTOP was 85.1 (T7-L1), 58.9 (T10-L1) and 77.9 cm² (T10-L1), respectively. There was statistically significant difference between area of dye spread between subcostal and mid-axillary approach (p<0.01).
This dye injection study in a cadaver model indicates that subcostal approach is associated with a larger area of spread of dye than the mid-axillary approach. Dye injected through subcostal, mid-axillary and LTOP approaches demonstrated different nerve involvement.
腹横肌平面（TAP）阻滞是一种为前腹壁提供镇痛的新技术。关于TAP阻滞的进针点存在持续的争论。本尸体研究的目的是比较使用三种不同的TAP阻滞方法（肋下、经腋中线和经Petit腰三角（LTOP））注入40毫升染料后的扩散情况。
对13具防腐处理的人体尸体的每侧半腹壁，通过3个不同的进针点（肋下（9个半腹部）、腋中线（9个）和LTOP（8个））向TAP注射黑色染料。随后进行解剖，以确定染料扩散的范围和染料注射所涉及的神经。将染料的形状描绘在透明塑料上，然后拍照。将这些数码照片加载到数学软件程序Matlab中，使用分段三次样条对染料扩散的轮廓进行数字化处理，从而能够在图表上绘制形状并计算面积。
肋下、腋中线和LTOP的染料扩散面积分别为85.1（T7-L1）、58.9（T10-L1）和77.9平方厘米（T10-L1）。肋下和腋中线注射方法的染料扩散面积之间存在统计学显著差异（p<0.01）。
该尸体模型中的染料注射研究表明，肋下注射方法比腋中线注射方法的染料扩散面积更大。通过肋下、腋中线和LTOP方法注射的染料显示出不同的神经累及情况。
