Sondekoppam R V, Brookes J, Morris L, Johnson M, Ganapathy S
Department of Anesthesiology and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada.
Acta Anaesthesiol Scand. 2015 Mar;59(3):369-76. doi: 10.1111/aas.12459. Epub 2015 Jan 13.
Bilateral dual transversus abdominis plane (BD-TAP) injections were devised to cover the T7-8 and L1 dermatomes, which are usually spared with classical and mid-axillary TAP injections. The purpose of this study was to delineate the vertical and lateral extent of injectate spread following a lateral to medial approach for TAP injections in embalmed cadavers.
Ultrasound-guided subcostal and lateral TAP injections were performed on nine embalmed cadavers using 30 ml of 0.5% methylcellulose (20 ml for subcostal and 10 ml for lateral injections) with a 12-cm Tuohy needle in the first six cadavers (nine hemi-abdomens). Vertical extent and the medial to lateral extent of the dye spread were recorded after dissections of the abdominal wall. In a pilot of three cadavers not receiving TAP injections, anatomical impediments to proximal injectate spread were explored separately.
The vertical spread of injectate was T7-L1 (n = 2/9), T8-L1 (n = 5/9) and T9-L1 (n = 2/9). None of the TAP injections extended beyond the mid-axillary line. No anatomical impediments for the flow of injectate to the T7 or T8 intercostal nerves were found at the level of the interdigitations of the transversus abdominis muscle and diaphragm.
A lateral to medial approach for TAP injection resulted in spread of the injectate ranging from T7/8-L1 dermatomes in the majority of the hemi-abdomens. Subcostal and lateral TAP injections do not cover the lateral cutaneous branches of the segmental nerves.
双侧腹横肌平面（BD-TAP）注射旨在覆盖T7-8和L1皮节，而经典的和腋中线腹横肌平面注射通常无法覆盖这些皮节。本研究的目的是在防腐尸体上描绘经外侧至内侧入路进行腹横肌平面注射后注射剂扩散的垂直和横向范围。
对9具防腐尸体进行超声引导下的肋下和外侧腹横肌平面注射，在前6具尸体（9个半腹部）中使用12厘米的Tuohy针注射30毫升0.5%的甲基纤维素（肋下注射20毫升，外侧注射10毫升）。在解剖腹壁后记录染料扩散的垂直范围以及从内侧到外侧的范围。在3具未接受腹横肌平面注射的尸体的预试验中，分别探索了注射剂向近端扩散的解剖学障碍。
注射剂的垂直扩散范围为T7-L1（n = 2/9）、T8-L1（n = 5/9）和T9-L1（n = 2/9）。没有一次腹横肌平面注射超出腋中线。在腹横肌与膈肌交叉处未发现注射剂流向T7或T8肋间神经的解剖学障碍。
经外侧至内侧入路进行腹横肌平面注射导致大多数半腹部的注射剂扩散范围为T7/8-L1皮节。肋下和外侧腹横肌平面注射不能覆盖节段神经的外侧皮支。
