Best needle for TAP block

[excalibur]

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Don't do TAP blocks often. Only did a couple in residency. Know quite well how to do them, and which pts may benefit. My problem is just visualizing the needle esp in obese pts. I use a 21 g 4 in stimuplex needle.

Are you guys just using Touhys?

Might have to check our supply room for prepackaged Tuohy needles. If you use a Tuohy, do u just attach the local filled syringe directly to Tuohy or connect some tubing between Tuohy and syringe?

Easier to see Tuohy? Easier to feel "pop" into fascia between muscle?

 

[RxBoy]

Don't do TAP blocks often. Only did a couple in residency. Know quite well how to do them, and which pts may benefit. My problem is just visualizing the needle esp in obese pts. I use a 21 g 4 in stimuplex needle.

Are you guys just using Touhys?

Might have to check our supply room for prepackaged Tuohy needles. If you use a Tuohy, do u just attach the local filled syringe directly to Tuohy or connect some tubing between Tuohy and syringe?

Easier to see Tuohy? Easier to feel "pop" into fascia between muscle?

I do quite a bit of taps. Use same needle as you.... Easiest to prep. Touhy is often too painful for the pt and I think overkill unless you want to throw a catheter in that space.

Tips that help me
1) Use minimal depth, image resolution decreases with depth size. I aim to just see a glimpse of the peritoneum.
2) Use some force on the probe to displace all that fat. Also collapses veins which is good.
3) Steep trajectory makes it more difficult to see needle in my experience. Sometimes you just have to be steep with the obese.
4) Most importantly... Obtain an excellent view of the layers and keep it that way. Small tilting or movement can sometimes cause pseudo facial planes to appear. This becomes a disaster when you start trying to find your needle.. Now you cant locate neither your needle or your target.

I focus less on getting the entire needle in view. I just look for tissue movement a lot time to know my depth and trajectory... Once you think your there, give a couple cc's. Usually I am a touch shallow. Every now and then you feel a pop as you advance. Give a couple more cc's and make sure your not through and through injecting into the transversalis (common as well). Pull back a touch and watch those layers split like an onion. Always feels great to see that split.

FYI: Do not inject because you think you're somewhere there. You need to see the split, otherwise abandon. Had a co resident back in residency infiltrate the transversalis muscle. Pt got up to use bathroom sometime after and pt fell and fractured ankle. Common to cause femoral nerve involvement if you inject too deep.

 

[BLADEMDA]

Over 200 tap blocks and counting. By far the best needle is a Pajunk tap block needle. Try it. You will love it.

 

[epidural man]

Don't do TAP blocks often. Only did a couple in residency. Know quite well how to do them, and which pts may benefit. My problem is just visualizing the needle esp in obese pts. I use a 21 g 4 in stimuplex needle.

Are you guys just using Touhys?

Might have to check our supply room for prepackaged Tuohy needles. If you use a Tuohy, do u just attach the local filled syringe directly to Tuohy or connect some tubing between Tuohy and syringe?

Easier to see Tuohy? Easier to feel "pop" into fascia between muscle?

I use a tuohy 20g or 22g for every block - it works great for TAPS as well.

 

[Oggg]

Limited experience but for fatties I go with 18g Tuohy 3.5" attached directly to syringe. To get the needle to come in perpendicular to the probe, you need to enter very far anterior to the probe, like 6cm

 

[BLADEMDA]

The Pajunk tap needle is very echogenic and the best needle on the market bar none. Once you use this needle difference between a touhy or basic stimuplex needle is readily apparent. I'm quite happy that I was Able to upgrade my u/s machine and needles. Now whether they are thin or super fat the better equipment makes doing a block quite simple.

 

[BLADEMDA]

http://www.youtube.com/watch?v=iVTCdP2HGVw

 

[Southpaw]

The Pajunk is nice, but expensive. It's been extremely rare that I haven't been able to visualize a 20g or 22g Tuohy, regardless of the block I'm doing.

 

[BLADEMDA]

The Pajunk is nice, but expensive. It's been extremely rare that I haven't been able to visualize a 20g or 22g Tuohy, regardless of the block I'm doing.

The Pajunk is nice in obese patients and subcostal/rectus sheath blocks. Standard tap blocks are fairly easy with a 22g tuohy.

Still, if you aren't paying for the equipment yourself then why not get "good stuff"? The surgeons don't worry about nickels and dimes. Think about it this way: If you avoid just one major complication by using the echogenic pajunk needle then it is was worth the cost.

 

[Oggg]

How about an Echogenic Tuohy? Has anyone tried one? Several companies -- here is pajunk's

http://www.pajunkadvantage.com/tuohy.php