Doyle’s bulge

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Gas you down

Gas you down

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“Doyle’s bulge” is basically what you see from an internal view of a tap block placed by surgeon.
but who was Doyle? I can’t find much with my Google-fu. Not a particularly interesting question, but I like to learn weird and useless crap...anyone know?
 
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Pre‐TAP block view from the laparoscopic camera directed at the antero‐lateral abdominal wall.
 
BLADEMDA said:
View attachment 313287
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All that I am seeing here is a bulge above the peritoneum. This could be caused by local anesthetic deposited just superficial to the peritoneum and beneath the transversus abdominus NOT above it as necessary for a true TAP block. To this day using laparoscopy to verify TAP block placement is a concept that escapes me
 
Hoya11 said:
All that I am seeing here is a bulge above the peritoneum. This could be caused by local anesthetic deposited just superficial to the peritoneum and beneath the transversus abdominus NOT above it as necessary for a true TAP block. To this day using laparoscopy to verify TAP block placement is a concept that escapes me
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It is highly likely some of the local would track back into the TAP plane. Anyway, my posts were in response to the OP about Dr. Doyle and his bulge.
 
Hoya11 said:
All that I am seeing here is a bulge above the peritoneum. This could be caused by local anesthetic deposited just superficial to the peritoneum and beneath the transversus abdominus NOT above it as necessary for a true TAP block. To this day using laparoscopy to verify TAP block placement is a concept that escapes me
Click to expand...

When placed just above the peritoneum, it looks more like a blister than a bulge.
 
Hoya11 said:
Blister vs Bulge...really? Its the surgeons looking to bill and not knowing how to use ultrasound or guide a needle in plane..
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This is the exact and only reason. That being said our bariatric guys will do attempt it in the ginormous belly's, which is probably a better shot than if we do it with ultrasound. Ultrasound TAP block on a morbid obese belly is absolutely painful
 
2Fast2Des said:
This is the exact and only reason. That being said our bariatric guys will do attempt it in the ginormous belly's, which is probably a better shot than if we do it with ultrasound. Ultrasound TAP block on a morbid obese belly is absolutely painful
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That's >90% of my TAP blocks...
 
What are your thoughts on QL's? Do you perform them? We've essentially transitioned 100% from TAP to QL blocks for all lap procedures. Easy to perform and well tolerated by the patients.

EDIT: primarily QL1


2Fast2Des said:
This is the exact and only reason. That being said our bariatric guys will do attempt it in the ginormous belly's, which is probably a better shot than if we do it with ultrasound. Ultrasound TAP block on a morbid obese belly is absolutely painful
Click to expand...
abolt18 said:
That's >90% of my TAP blocks...
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MirrorTodd said:
What are your thoughts on QL's? Do you perform them? We've essentially transitioned 100% from TAP to QL blocks for all lap procedures. Easy to perform and well tolerated by the patients.
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I haven't done one yet but if it's easier to perform and as efficacious then I'm happy to learn. Can they be done supine?
 
2Fast2Des said:
I haven't done one yet but if it's easier to perform and as efficacious then I'm happy to learn. Can they be done supine?
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We always have the patient go lateral. It probably could be done supine, but you might run out of room for the probe since we go fairly lateral (like just past the mid axillary line).
 
I have done exactly zero QL blocks. Hope to learn this year.
MirrorTodd said:
What are your thoughts on QL's? Do you perform them? We've essentially transitioned 100% from TAP to QL blocks for all lap procedures. Easy to perform and well tolerated by the patients.

EDIT: primarily QL1
Click to expand...
 
MirrorTodd said:
We always have the patient go lateral. It probably could be done supine, but you might run out of room for the probe since we go fairly lateral (like just past the mid axillary line).
Click to expand...

Which one is easiest to do? Of the QLs
 
The question is not what QL block is easiest (QL1) but which one works best for post op analgesia. Typically, you should place a bump under the patient in the supine position when performing a QL1 block as this really helps with placement of the probe. Lateral positioning is the best but takes too much time because typically we are doing bilateral QL1 blocks so the "bump" is easier and faster.
 
2Fast2Des said:
This is the exact and only reason. That being said our bariatric guys will do attempt it in the ginormous belly's, which is probably a better shot than if we do it with ultrasound. Ultrasound TAP block on a morbid obese belly is absolutely painful
Click to expand...
I don’t even bother doing them. I will let the surgeon penetrate the intra-abdominal area.
 
Gas you down said:
“Doyle’s bulge” is basically what you see from an internal view of a tap block placed by surgeon.
but who was Doyle? I can’t find much with my Google-fu. Not a particularly interesting question, but I like to learn weird and useless crap...anyone know?
Click to expand...
From the title I thought Doyle might be the last name of Wood, the guy from all the Covid memes.
 
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