Doyle’s bulge
Started by Gas you down
Just waiting for Salty’s reply...
Error - Cookies Turned Off
Advertisement - Members don't see this ad
Pre‐TAP block view from the laparoscopic camera directed at the antero‐lateral abdominal wall.
Post‐TAP block. ‘Doyles’ internal‐bulge sign’ reflecting visible local anaesthetic infiltration into the TAP.
Error - Cookies Turned Off
P. Doyle
Charing Cross Hospital London U.K.
Anaesthesia
. 2011 Apr;66(4):317-8.
doi: 10.1111/j.1365-2044.2011.06664.x.
Laparoscopic assisted transversus abdominis plane block: a novel insertion technique during laparoscopic nephrectomy
A Chetwood, S Agrawal, D Hrouda, P Doyle
- PMID: 21401554
- DOI: 10.1111/j.1365-2044.2011.06664.x
Patrick Doyle
Department of Anaesthetics, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
( I believe that is the person the OP was looking for)
Department of Anaesthetics, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
( I believe that is the person the OP was looking for)
Advertisement - Members don't see this ad
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
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.
When placed just above the peritoneum, it looks more like a blister than a bulge.
D
deleted162650
Blister vs Bulge...really? Its the surgeons looking to bill and not knowing how to use ultrasound or guide a needle in plane..
Okay now do Throckmorton? Who is this mystery person ? This is also bulge related.
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
That's >90% of my TAP blocks...
Advertisement - Members don't see this ad
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
EDIT: primarily QL1
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?
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.
Which one is easiest to do? Of the QLs
D
deleted59964
was hoping for so much more from this thread
Easiest? Probably the intramuscular QL, put the needle in the muscle and inject. Finessing the needle into the plane above the QL for a QL1, is just as easy as putting it into the TAP but does take a wee bit of skill. The block can be done supine (likely depends on pt selection) but you can see that here.
Ultrasound-Guided Quadratus Lumborum Block: An Updated Review of Anatomy and Techniques
Advertisement - Members don't see this ad
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.
The bump helps you position the probe posterior enough to see the end of the TA muscle and the start of the QL fascia.
I don’t even bother doing them. I will let the surgeon penetrate the intra-abdominal area.
O'Doyle Rules!
From the title I thought Doyle might be the last name of Wood, the guy from all the Covid memes.
