its a rectus sheeth block, not a tap and does theoretically have some periumbilical coverage. Since TAP blocks are reliably unreliable, its hard to tell the difference so they typically get away with it. I gave a lecture to surgeons explaining the difference and there was a lot of head scratching and the practice continued..
Last week a Urologist inserted a "TAP block" under "direct vision" using a new technique they read about.
Step 1: Put one hand through the midline incision and place it within the peritoneum palm up.
Step 2: Exert outward pressure on the abdominal wall with said hand; lifting it up like a pneumoperitoneum and causing tenting of the skin where their fingers were pushing out as a visual landmark.
Step 3: Insert the (?Tuohy-looking) needle through the skin (from external --> internal) with their free hand.
Step 4: Explained to the trainee "I now walk the needle tip off the peritoneum by feeling its location with my internal hand."
Needlesticked themselves immediately.
Step 1: Put one hand through the midline incision and place it within the peritoneum palm up.
Step 2: Exert outward pressure on the abdominal wall with said hand; lifting it up like a pneumoperitoneum and causing tenting of the skin where their fingers were pushing out as a visual landmark.
Step 3: Insert the (?Tuohy-looking) needle through the skin (from external --> internal) with their free hand.
Step 4: Explained to the trainee "I now walk the needle tip off the peritoneum by feeling its location with my internal hand."
Needlesticked themselves immediately.
that cant be a real story!
When the surgeon does their "tap" block, all the local seems to just bunch up like a huge welt where they injected. When we do an ultrasound guided block, is that what it looks like? I can't imagine so since the transverse abdominis is the last layer being injected against, and muscle wouldn't look so floppy like mucosa. How much clinical effect is there vs surgeon tap vs ultrasound tap?
Unfortunately it was. They also didn't secure the catheter in the aftermath and it fell out when they removed the drapes.
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deleted162650
They’re not actually doing a tap. They’re injecting right under the peritoneum.
Do any of you do rectus sheath blocks? For big midline laparotomy cases I’ve always done bilateral TAPs to cover the lower portion and bilateral rectus sheaths a few inches below the xiphoid to cover the upper portion. Did it a lot in fellowship for those sick big belly cases we were trying to extubate but we’re having difficulty because they needed to be snowed to tolerate the pain, works great.
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deleted875186
Anyone doing erector spinae blocks for ex laps and abdominal incisions?
Our group is doing more Quadratus Lumborum blocks (bit of a learning curve but very forgiving block), especially post-op.
I've done a fair amount of rectus sheath and subcostal tap blocks for ex lap. Works pretty well. Erector spinae is great but obviously position is an issue, and many of our abdominal blocks are post-op.
We started doing those and I thought it was made up mumbo jumbo, but we have seen some good results.
We're doing those in our teaching hospital.
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