Mavarez Ana C., Hendrix Joseph Maxwell, Ahmed Andaleeb A.
Wellstar MCG Health at Augusta University
Worldwide Clinical Trials
Regional anesthesia for abdominal wall procedures can be performed using a variety of peripheral nerve blocks. These blocks are typically ultrasound (US) guided and involve injecting a local anesthetic (LA) solution into interfascial planes. US-guided transversus abdominis plane (TAP) block involves the injection of LA in between the transversus abdominis (TA) and internal oblique (IO) muscles. The TAP block can also be targeted using anatomical landmarks at the level of the Petit triangle. This interfascial plane contains the intercostal, subcostal, iliohypogastric, and ilioinguinal nerves. These nerves give sensation to the anterior and lateral abdominal wall and the parietal peritoneum, providing only somatic and not visceral analgesia. The TAP block can be used for postoperative analgesia management in open and laparoscopic abdominal surgeries and inpatient and outpatient surgical procedures. Unilateral left- or right-sided blocks are used for unilateral surgical procedures, such as cholecystectomy, appendectomy, nephrectomy, or renal transplants. In contrast, bilateral TAP blocks are used for midline and transverse abdominal incisions, such as umbilical or ventral hernia repair, cesarean deliveries, hysterectomy, and prostatectomy. TAP blocks are part of multimodal pain management for abdominal surgeries, which adds analgesic benefit to patients, reducing postoperative opioid requirements. TAP blocks are typically placed intraoperatively, either before the surgical incision or at the end of the procedure before emergence from anesthesia. The TAP block's efficacy depends on the spread of LA across the interfacial plane. Newer tissue plane blocks, like the quadratus lumborum block, provide somatic and visceral analgesia. The TAP block has become one of the most common truncal blocks performed for postoperative analgesia after abdominal surgeries. This activity reviews the anatomy of the abdominal wall, the history of the TAP block, classification, approaches, techniques, and complications for this block. It also highlights the indications, contraindications, clinical significance, and materials to perform this block safely.
腹壁手术的区域麻醉可通过多种外周神经阻滞来实施。这些阻滞通常在超声（US）引导下进行，包括将局部麻醉药（LA）溶液注入筋膜间隙平面。超声引导下的腹横肌平面（TAP）阻滞是将LA注射到腹横肌（TA）和腹内斜肌（IO）之间。TAP阻滞也可在腰下三角水平使用解剖标志来定位。这个筋膜间隙平面包含肋间神经、肋下神经、髂腹下神经和髂腹股沟神经。这些神经为腹壁前外侧和壁腹膜提供感觉，仅提供躯体性而非内脏性镇痛。TAP阻滞可用于开放和腹腔镜腹部手术以及住院和门诊手术的术后镇痛管理。单侧左侧或右侧阻滞用于单侧手术，如胆囊切除术、阑尾切除术、肾切除术或肾移植。相比之下，双侧TAP阻滞用于中线和腹部横切口，如脐疝或腹疝修补术、剖宫产、子宫切除术和前列腺切除术。TAP阻滞是腹部手术多模式疼痛管理的一部分，可为患者增加镇痛益处，减少术后阿片类药物的需求。TAP阻滞通常在术中进行，要么在手术切口前，要么在手术结束麻醉苏醒前。TAP阻滞的效果取决于LA在界面平面的扩散。较新的组织平面阻滞，如腰方肌阻滞，可提供躯体性和内脏性镇痛。TAP阻滞已成为腹部手术后最常用于术后镇痛的躯干阻滞之一。本活动回顾了腹壁的解剖结构、TAP阻滞的历史、分类、入路、技术和并发症。它还强调了进行该阻滞的适应证、禁忌证、临床意义和安全实施该阻滞的材料。
