Tap blocks

[amyl]

So in my pp gig the taps seemed to work ok.... I don't know if they are using a different dose or what but Where I am now (I'm not doing the blocks myself the team is) they don't seem to work too well. What is everyone's experience here with taps

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[pgg]

We do a lot of them. They work great for abd wall pain below the umbilicus. Above that, the patients probably need rectus sheath blocks. They don't do a thing for visceral pain.

 

[PainDrain]

I have good results with the ones I do. I typically use 0.5% bupi and like PGG said it all depends on where the cut is. If it's above the umbilicus I will do a rectus sheath block also.

 

[ZzzPlz]

When I dilute the local with ketamine they work alright

 

[ZzzPlz]

Otherwise hit or miss

 

[Pooh & Annie]

When I dilute the local with ketamine they work alright

It's the systemic effect. I doubt it's doing anything to your block. Might as well give it IV

 

[Planktonmd]

I suggest diluting it with Ketamine, Ketoralac, Dexamethasone, and Morphine... Guaranteed to work!

 

[deleted9493]

I have used them several times on puny babies getting open g-tubes with good results using a subcostal TAP approach (http://www.csen.com/Hebbard.pdf)

Because it doesn't cover the viscera, it's not a be all end all but it does make extubation a lot easier for some of these kids. I use .2% Ropiv w/ .1mg/kg of PF dexamethasone.

 

[deleted162650]

As I said in another thread: TAPS, 50% of the time, they work every time. I agree that they really only help below the umbilicus, and even then I don't find them all that great for midline incisions. I like em for Ing. Hernias and Pfannenstiel incisions though. Could also just be that your team sucks?

 

[fakin' the funk]

Keep your (and your surgeons') expectations low with TAPs and you'll be just fine. As others said, if they work, it's only for the abdominal wall for the umbilicus at all. I like to do 30-40 ml 0.25% bupi w/ epi each side, and I like to do them under GA at the beginning of the case, after induction.

 

[Ignatius J]

Keep your (and your surgeons') expectations low with TAPs and you'll be just fine. As others said, if they work, it's only for the abdominal wall for the umbilicus at all. I like to do 30-40 ml 0.25% bupi w/ epi each side, and I like to do them under GA at the beginning of the case, after induction.

Our PACU nurses swear by them, depending on the provider. But they do notice differences. I think I can get T8-9ish.

 

[wickedskillz]

we do em with exparel at my residency program. ive seen people have numbness over abd wall (decreased cold with ice) 2 days later when following on pain service. that said, it wont be a super dense block, consider it to be part of your multimodal regimen