TAP blocks - yay or nay?

[UscGhost]

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illogical statements and incorrect, irrelevant answer to the question asked - is it necessary?

last i checked, it’s not standard of care or even considered best practice that it needs/should be done unequivocally on all patients…

Standard of care is the bare minimum...not a level to strive for

So far the data shows that they work. So i have yet to here a legitimate reason to not do them.

TAP blocks are a part of multimodal pain control, which is best practice

 

[UscGhost]

To be fair, plenty of data now that ~10-15% of patients sent home from surgery on narcotics will still be on them a year later. A lot of not "addicts" but medical chronic pain patients. Doesn't even seem to matter too much whether the initial surgery was a CABG or a ureteroscopy, clearly there is something in the pathophysiology of chronic pain that makes some more susceptible then others. So i am all in favor of anything to reduce post op narc use.

That said, i haven't seen any effect from TAPs, where they were done where i trained and not where i practice. I'm not against them in principle, but refuse them when asked in particular cases, because since it is not "protocol", im signing up for 20 extra minutes unless there is a specific reason. Plus i use plenty of local both before and after incisions.

Speaking of post-op pain, you guys having any luck getting suzetrigine available/approved?

Should only take 3 mins in an avg patient if the operator is skilled and prepared.

Plenty of docs aren't capable of doing them quickly and efficiently. I get lots of business diverted my way because of that.

Seeing an post op effect from a surgeons perspective is variable. Usually surgeons arent called for pacu pain, and only if pain meds are needed above abd beyond the standard order sets

Local infiltration is also very helpful. Some surgeons overlook its importance unfortunately. "They are getting GA, so i don't need local"...

 

[AKMD_1984]

Standard of care is the bare minimum...not a level to strive for

So far the data shows that they work. So i have yet to here a legitimate reason to not do them.

TAP blocks are a part of multimodal pain control, which is best practice

so are spinals…anything non narcotic can be considered “multimodal”.
why not do opioid spinals then since technically they’ll make more sense…they help with pain too.

you are extrapolating that it’s best practice. do you know the difference between standard of care and best practices? they’re determined after rigorous criteria and data

routine tap for appy/ chole does not meet that criteria so kindly stop proposing it as such

 

[Howard888]

tap blocks for lap appys. Absolute insanity and fraud. One dose of extra narcotic isn’t detrimental at all and I don’t even think that they get one extra dose. Your residency program is either worst in county or shouldn’t have let you graduate

 

[UscGhost]

so are spinals…anything non narcotic can be considered “multimodal”.
why not do opioid spinals then since technically they’ll make more sense…they help with pain too.

you are extrapolating that it’s best practice. do you know the difference between standard of care and best practices? they’re determined after rigorous criteria and data

routine tap for appy/ chole does not meet that criteria so kindly stop proposing it as such

Opiod spinals for what case?

AI disagrees with you

are nerve blocks considered best practices for post laparoscopic abdominal pain

Yes,
nerve blocks (like TAP & RSB) are increasingly recognized as effective, best-practice components for post-laparoscopic pain management, offering good opioid-sparing relief with fewer side effects, though specific blocks (like RSB) might vary in effectiveness, and evidence quality is still maturing. They're part of a multimodal approach, reducing opioid reliance, but evidence quality can vary,

 

[Howard888]

Insanity absolutely insane

 

[Maz777]

This clown is going to die on this hill. He’s doing TAP blocks for adult appy’s based on zero evidence. Citing one completely irrelevant pediatric RCT in OPEN APPENDECTOMIES in the Egyptian Journal of Anesthesia (and generative AI) as his justification. An outlier who never questions why he is an outlier. Just that everyone else in the world is wrong.

We all know that doing TAP blocks for appy’s is asinine.

It’s like doing a rescue postop block in the PACU on someone having zero pain. Sure, it can be done, but it’s still asinine.

 

[UscGhost]

This clown is going to die on this hill. He’s doing TAP blocks for adult appy’s based on zero evidence. Citing one pediatric RCT (and generative AI) as his justification. An outlier who never questions why he is an outlier. Just that everyone else in the world is wrong.

We all know that doing TAP blocks for appy’s is asinine.

It’s like doing a rescue postop block in the PACU on someone having zero pain. Sure, it can be done, but it’s still asinine.

Posted a bunch for ya.

Its ok. Many practices are full of the stubborn old heads. Regional is tough for you guys to learn

 

[Maz777]

Posted a bunch for ya.

Its ok. Many practices are full of the stubborn old heads. Regional is tough for you guys to learn

As I have said countless times, you have yet to post a SINGLE study showing improved analgesia with TAP blocks in lap appy’s. You clearly have zero idea how to review the literature. Apparently it’s difficult to read a publication and discern that they are investigating open appendectomies and not lap appy’s. Reading is tough.

 

[UscGhost]

Couple more for ya. So far i have posted articles on lap gyn, lap chole and lap appy. All three surgeries use 3-4 port sites, depending on approach.

I am sure they have some regional training courses that you can sign up for in your area

https://lapend.org/jvi.aspx?un=LESS-27928&volume=25&issue=4

Results: The mean VAS score in LA+TAP-block group was 3.1±2.1; 3.3±2.1; 3.9±2.3; 4.2±2.6 and 4.3±3 on
the 0th; 2th; 6th; 16th and 24th hours and 4±1.5; 4.7±2.2; 6±2; 6.2±2 and 5.9±2 on the 0th; 2th; 6th; 16th and 24th
hours in only LA group, respectively. Postoperative abdominal pain was significantly less in LA+TAP-block
group than the LA group at 2th (p=0.01), 6th (p<0.01), 16th (p<0.001) and 24th (p=0.01) hours. Although, sta-
tistically not significant, TAP-block was associated with more quickly to return to normal activities

https://www.researchgate.net/publication/376003987_A_randomised_controlled_trial_to_study_the_analgesic_efficacy_of_transversus_abdominis_plane_block_for_adult_undergoing_elective_laparoscopic_appendectomy

Results: A total of 20 patients were included in the control group and 19 in the TAP block group. Visual analog scale scores were significantly reduced in the TAP block group at 6 hours, 12 hours, and 18 hours (p<0.001 in each). However, there was no significant reduction in the visual analog scale score at 24 hours (p=0.015). There was no significant difference between postoperative nausea (p=0.18), and length of postoperative hospital stay (p=0.93) between the two groups. Consumption of rescue analgesics and antiemetics in the first 24 hours postoperatively between both groups was statistically significant (p=0.005). Conclusions: Bilateral TAP block is safe and effective in reducing the need for analgesics and antiemetics in patients undergoing laparoscopic appendectomy in the postoperative period. In addition, there is a significant improvement in visual analog scale scores in patients after TAP block. Keywords: Laparoscopy, Appendectomy, Transversus abdominis

 

[Dantrolene FC]

Posted a bunch for ya.

Its ok. Many practices are full of the stubborn old heads. Regional is tough for you guys to learn

Dude… I graduated, very recently, from a program that got called out in the media for doing too may TAP blocks… and even they didn’t do TAP blocks for lap appys, because it’s crazy.

 

[UscGhost]

Dude… I graduated, very recently, from a program that got called out in the media for doing too may TAP blocks… and even they didn’t do TAP blocks for lap appys, because it’s crazy.

Link to the news story?

 

[AKMD_1984]

Posted a bunch for ya.

Its ok. Many practices are full of the stubborn old heads. Regional is tough for you guys to learn

ummm….anesthesia pain here
15 years experienced
proficient in both fluoro and ultrasound
mean time for simple b/b us blocks from start to finish - 2.5 minutes
0 complications or poor outcome.
rare to do repeat or rescue blocks in pacu
haven’t done a single one this year
never did taps for chole/appy

i have an outpatient/ asc b/b practice with mostly ortho/vascuiar/ gen surg/spine. we do esp for dlif/alif. 95% solo. 5% medical direction.

for pain - mean time for cervical esi - contra lateral oblique views - 4-5 minutes. two level lumbar tfesi 6 minutes
SCS trials 15-20 minutes
0 complications or poor outcome.

0 complications or poor outcomes is not because of our ability…it’s because of appropriate patient selection and right indication.

it’s not about seeing the damn needle on screen…or “comfort” or “skill”

you’re missing the point and i’m afraid being aggressive with tap with questionable indication is just a marker for future over zealousness with injections and you will do an unnecessary procedure on someone some day

 

[Hoya11]

Couple more for ya. So far i have posted articles on lap gyn, lap chole and lap appy. All three surgeries use 3-4 port sites, depending on approach.

I am sure they have some regional training courses that you can sign up for in your area

https://lapend.org/jvi.aspx?un=LESS-27928&volume=25&issue=4

Results: The mean VAS score in LA+TAP-block group was 3.1±2.1; 3.3±2.1; 3.9±2.3; 4.2±2.6 and 4.3±3 on
the 0th; 2th; 6th; 16th and 24th hours and 4±1.5; 4.7±2.2; 6±2; 6.2±2 and 5.9±2 on the 0th; 2th; 6th; 16th and 24th
hours in only LA group, respectively. Postoperative abdominal pain was significantly less in LA+TAP-block
group than the LA group at 2th (p=0.01), 6th (p<0.01), 16th (p<0.001) and 24th (p=0.01) hours. Although, sta-
tistically not significant, TAP-block was associated with more quickly to return to normal activities

https://www.researchgate.net/publication/376003987_A_randomised_controlled_trial_to_study_the_analgesic_efficacy_of_transversus_abdominis_plane_block_for_adult_undergoing_elective_laparoscopic_appendectomy

Results: A total of 20 patients were included in the control group and 19 in the TAP block group. Visual analog scale scores were significantly reduced in the TAP block group at 6 hours, 12 hours, and 18 hours (p<0.001 in each). However, there was no significant reduction in the visual analog scale score at 24 hours (p=0.015). There was no significant difference between postoperative nausea (p=0.18), and length of postoperative hospital stay (p=0.93) between the two groups. Consumption of rescue analgesics and antiemetics in the first 24 hours postoperatively between both groups was statistically significant (p=0.005). Conclusions: Bilateral TAP block is safe and effective in reducing the need for analgesics and antiemetics in patients undergoing laparoscopic appendectomy in the postoperative period. In addition, there is a significant improvement in visual analog scale scores in patients after TAP block. Keywords: Laparoscopy, Appendectomy, Transversus abdominis

IMO part of being a good regionalist is being experienced enough to know what is kool-aid and what is actually helping patients.

In these times, there are LOTS of BS blocks and papers that support it - for the authors notoriety, or for commercial reasons, or both. The field is flooded with BS. You have to be able to sort out what works and what doesn't. Relying on barely stastically significant manipulated papers - youve got to be better than that. Look at the real world outcomes, are patients significantly better than without the block? This is the toughest part of regional anesthesia today. Truly being an expert means you dont just do whatever the latest trend is just because the new article said it would help. You have to form your own opinion, and those opinions and those practices becomes your reputation as a regionalist. Doing blocks that dont significantly impact patient experience, while you may be thinking who cares, others are probably silently judging your inability to see through the BS. Oh that Dr. He always does TAP blocks for Lap Appys, thinks hes the bees knees of regional, eye roll and give percocet..

As a regionalist thats not who I want to be. If i see some BS coming out, I want to be the first to call BS and have it be known that Im not a cog of industry or academia. I have independent thought and will apply it to my patients best outcomes. Believing every single study that comes out about all these new "soft" blocks - you shouldnt be so gullible. Have a threshold of skepticism.

Hows pacira pharmaceuticals doing? Hows that exparel working out? Does anyone know about IOVERA procedure (also by pacira)? How about the new suzetrigine? This is a company flooding the market with BS (but literature supported) products. Surgeons are buying into it, some anesthesiologists ( a minority) are buying into it. Im not. I know industry when I see it. Look up some of the efficacy data on those products, talk to some patients, and see if you believe it. Its industry BS. It's everywhere. You have to be able to sort that out as a good regionalist. Its remembered when your on the wrong side of history and you were expounding on the greatness of exparel at one point - maybe this person isnt a good judge of true block success if they believed that right?.

To me the strongest argument for a new block working is a strong, skeptical, experienced regional anesthesiologist telling me give this a try I've had positive experience with it. At this point in my career, I pay little attention to the articles and the bias that they bring.If you truly observe that your patients are doing better with the TAP, then do it. If its something you think you "should" be doing for "multimodal analgesia" I would think again

 

[Hoya11]

ummm….anesthesia pain here
15 years experienced
proficient in both fluoro and ultrasound
mean time for simple b/b us blocks from start to finish - 2.5 minutes
0 complications or poor outcome.
rare to do repeat or rescue blocks in pacu
haven’t done a single one this year
never did taps for chole/appy

i have an outpatient/ asc b/b practice with mostly ortho/vascuiar/ gen surg/spine. we do esp for dlif/alif. 95% solo. 5% medical direction.

for pain - mean time for cervical esi - contra lateral oblique views - 4-5 minutes. two level lumbar tfesi 6 minutes
SCS trials 15-20 minutes
0 complications or poor outcome.

0 complications or poor outcomes is not because of our ability…it’s because of appropriate patient selection and right indication.

it’s not about seeing the damn needle on screen…or “comfort” or “skill”

you’re missing the point and i’m afraid being aggressive with tap with questionable indication is just a marker for future over zealousness with injections and you will do an unnecessary procedure on someone some day

0 complications in 15 years with a heavy injection practice? i thought we were all being real

 

[AKMD_1984]

0 complications in 15 years with a heavy injection practice? i thought we were all being real

yes, knock on wood. I'm sure it will happen. But nothing yet and nothing even close to being a major complication or lawsuit. I do have to do blood patches for the myelograms I do, but thats not really a complication - its a known adverse event that one must deal with.
But no hematoma, no nerve injury, no abscess. Yes occasional failed block but none this year as far as I can recall where I have to do a rescue block in PACU.

I am very careful in patient selection and actual indication. If I foresee complications or difficulty I don't even do the injection. Its not worth it.

 

[UscGhost]

IMO part of being a good regionalist is being experienced enough to know what is kool-aid and what is actually helping patients.

In these times, there are LOTS of BS blocks and papers that support it - for the authors notoriety, or for commercial reasons, or both. The field is flooded with BS. You have to be able to sort out what works and what doesn't. Relying on barely stastically significant manipulated papers - youve got to be better than that. Look at the real world outcomes, are patients significantly better than without the block? This is the toughest part of regional anesthesia today. Truly being an expert means you dont just do whatever the latest trend is just because the new article said it would help. You have to form your own opinion, and those opinions and those practices becomes your reputation as a regionalist. Doing blocks that dont significantly impact patient experience, while you may be thinking who cares, others are probably silently judging your inability to see through the BS. Oh that Dr. He always does TAP blocks for Lap Appys, thinks hes the bees knees of regional, eye roll and give percocet..

As a regionalist thats not who I want to be. If i see some BS coming out, I want to be the first to call BS and have it be known that Im not a cog of industry or academia. I have independent thought and will apply it to my patients best outcomes. Believing every single study that comes out about all these new "soft" blocks - you shouldnt be so gullible. Have a threshold of skepticism.

Hows pacira pharmaceuticals doing? Hows that exparel working out? Does anyone know about IOVERA procedure (also by pacira)? How about the new suzetrigine? This is a company flooding the market with BS (but literature supported) products. Surgeons are buying into it, some anesthesiologists ( a minority) are buying into it. Im not. I know industry when I see it. Look up some of the efficacy data on those products, talk to some patients, and see if you believe it. Its industry BS. It's everywhere. You have to be able to sort that out as a good regionalist. Its remembered when your on the wrong side of history and you were expounding on the greatness of exparel at one point - maybe this person isnt a good judge of true block success if they believed that right?.

To me the strongest argument for a new block working is a strong, skeptical, experienced regional anesthesiologist telling me give this a try I've had positive experience with it. At this point in my career, I pay little attention to the articles and the bias that they bring.If you truly observe that your patients are doing better with the TAP, then do it. If its something you think you "should" be doing for "multimodal anesthesia" I would think again

Thats nice. I am sure that the literature is flooded with data put out by the TAP block lobby.

In terms of exparel. I dont use it. I didnt see studies that compared it to 0.5 bupiv with dex. Not sure if thats changed in the last couple years. And anecdotally its all over the place.

Fortunately, i dont need to rely on a "single study". There are lots of them.

"Lots of BS" papers isnt a valid counterargument. Its vague and generalized.

I do them because they work and patients do better. The surgeons request them, because they feel their patients do better. If you prefer to just give you patients more percocet and dilaudid... go for it. Statistically, a percentage of those patients will also get more nausea and require more anti emetics. Is it life saving? Nope. Then again, for 3 mins of my time and $10 in materials with no complications in 15 years..worth it

If you want to argue that you dont do them because your appys and chole take 20 mins and the surgeons inject 15ml of local per port site... that's good. I probably wouldn't either in that situation..but the vast majority of surgeons i see inject 3ml per site and take 1-4 hrs. Different ballgame

 

[AKMD_1984]

IMO part of being a good regionalist is being experienced enough to know what is kool-aid and what is actually helping patients.

In these times, there are LOTS of BS blocks and papers that support it - for the authors notoriety, or for commercial reasons, or both. The field is flooded with BS. You have to be able to sort out what works and what doesn't. Relying on barely stastically significant manipulated papers - youve got to be better than that. Look at the real world outcomes, are patients significantly better than without the block? This is the toughest part of regional anesthesia today. Truly being an expert means you dont just do whatever the latest trend is just because the new article said it would help. You have to form your own opinion, and those opinions and those practices becomes your reputation as a regionalist. Doing blocks that dont significantly impact patient experience, while you may be thinking who cares, others are probably silently judging your inability to see through the BS. Oh that Dr. He always does TAP blocks for Lap Appys, thinks hes the bees knees of regional, eye roll and give percocet..

As a regionalist thats not who I want to be. If i see some BS coming out, I want to be the first to call BS and have it be known that Im not a cog of industry or academia. I have independent thought and will apply it to my patients best outcomes. Believing every single study that comes out about all these new "soft" blocks - you shouldnt be so gullible. Have a threshold of skepticism.

Hows pacira pharmaceuticals doing? Hows that exparel working out? Does anyone know about IOVERA procedure (also by pacira)? How about the new suzetrigine? This is a company flooding the market with BS (but literature supported) products. Surgeons are buying into it, some anesthesiologists ( a minority) are buying into it. Im not. I know industry when I see it. Look up some of the efficacy data on those products, talk to some patients, and see if you believe it. Its industry BS. It's everywhere. You have to be able to sort that out as a good regionalist. Its remembered when your on the wrong side of history and you were expounding on the greatness of exparel at one point - maybe this person isnt a good judge of true block success if they believed that right?.

To me the strongest argument for a new block working is a strong, skeptical, experienced regional anesthesiologist telling me give this a try I've had positive experience with it. At this point in my career, I pay little attention to the articles and the bias that they bring.If you truly observe that your patients are doing better with the TAP, then do it. If its something you think you "should" be doing for "multimodal analgesia" I would think again

good. 👍

 

[GassYous]

A lot of surgeons are putting exparel in their local because they notice a decrease in phone calls postop

I just saw a chart where an anesthesiologist did bilateral tap blocks and paravertebral blocks for a lap appy and thought of this thread

 

[AKMD_1984]

A lot of surgeons are putting exparel in their local because they notice a decrease in phone calls postop

I just saw a chart where an anesthesiologist did bilateral tap blocks and paravertebral blocks for a lap appy and thought of this thread

lol 😆

 

[UscGhost]

yes, knock on wood. I'm sure it will happen. But nothing yet and nothing even close to being a major complication or lawsuit. I do have to do blood patches for the myelograms I do, but thats not really a complication - its a known adverse event that one must deal with.
But no hematoma, no nerve injury, no abscess. Yes occasional failed block but none this year as far as I can recall where I have to do a rescue block in PACU.

I am very careful in patient selection and actual indication. If I foresee complications or difficulty I don't even do the injection. Its not worth it.

Absolutely.

Patient selection is a calculation based on anticipated degree of benefits, cost, and risk of complications

Myelograms are costly, risks are very significant and impactful when they occur (while rare), so the anticipated benefits should scale accordingly.

A tap block takes 3 mins, costs $10 in materials and risks are virtually 0. So if that allows me to reduce opioid use, improve pain scores and reduce anti emetics. Ill take it. I don't need it to cure cancer

That being said..the pain speciality itself is rife with abuse and fraud (not implying that you are doing anything like that)

 

[UscGhost]

A lot of surgeons are putting exparel in their local because they notice a decrease in phone calls postop

I just saw a chart where an anesthesiologist did bilateral tap blocks and paravertebral blocks for a lap appy and thought of this thread

There was a surge in exparel when the reps went around to all the surgeons offices.

Hospitals took it off formulary.

Anecdotally, some patients would seem to report being numb for days. Others it would last the same time. Some patients got anxious if their block lasted beyond 24 hrs.

Appeared that blocks wore off less suddenly with exparel vs ropiv? Adding decadron to bupiv is supposed to accomplish the same effect.

Then again, i have come across some anes who "want their blocks to be partially worn off in pacu, so that patients can feel the pain a bit and aren't caught off guard late in the evening"

Different strategies i guess

 

[Maz777]

IMO part of being a good regionalist is being experienced enough to know what is kool-aid and what is actually helping patients.

In these times, there are LOTS of BS blocks and papers that support it - for the authors notoriety, or for commercial reasons, or both. The field is flooded with BS. You have to be able to sort out what works and what doesn't. Relying on barely stastically significant manipulated papers - youve got to be better than that. Look at the real world outcomes, are patients significantly better than without the block? This is the toughest part of regional anesthesia today. Truly being an expert means you dont just do whatever the latest trend is just because the new article said it would help. You have to form your own opinion, and those opinions and those practices becomes your reputation as a regionalist. Doing blocks that dont significantly impact patient experience, while you may be thinking who cares, others are probably silently judging your inability to see through the BS. Oh that Dr. He always does TAP blocks for Lap Appys, thinks hes the bees knees of regional, eye roll and give percocet..

As a regionalist thats not who I want to be. If i see some BS coming out, I want to be the first to call BS and have it be known that Im not a cog of industry or academia. I have independent thought and will apply it to my patients best outcomes. Believing every single study that comes out about all these new "soft" blocks - you shouldnt be so gullible. Have a threshold of skepticism.

Hows pacira pharmaceuticals doing? Hows that exparel working out? Does anyone know about IOVERA procedure (also by pacira)? How about the new suzetrigine? This is a company flooding the market with BS (but literature supported) products. Surgeons are buying into it, some anesthesiologists ( a minority) are buying into it. Im not. I know industry when I see it. Look up some of the efficacy data on those products, talk to some patients, and see if you believe it. Its industry BS. It's everywhere. You have to be able to sort that out as a good regionalist. Its remembered when your on the wrong side of history and you were expounding on the greatness of exparel at one point - maybe this person isnt a good judge of true block success if they believed that right?.

To me the strongest argument for a new block working is a strong, skeptical, experienced regional anesthesiologist telling me give this a try I've had positive experience with it. At this point in my career, I pay little attention to the articles and the bias that they bring.If you truly observe that your patients are doing better with the TAP, then do it. If its something you think you "should" be doing for "multimodal analgesia" I would think again

Solid advice.

This clown clearly graduated from one of those pump and dump fake fellowship programs that doesn't teach their fellows anything about discerning evidence, proper patient selection, proper indications, etc. Just do as many blocks as you can because you are told to and finish your fake fellowship without at all being an expert in regional anesthesia.

Completely agree that the field has become watered down with questionable blocks for questionable indications resulting in questionable efficacy. The RAAPM effect.

This guy will get what is coming to him though. You act like a block jock without thinking and you'll eventually get burned enough times.

 

[UscGhost]

Solid advice.

This clown clearly graduated from one of those pump and dump fake fellowship programs that doesn't teach their fellows anything about discerning evidence, proper patient selection, proper indications, etc. Just do as many blocks as you can because you are told to and finish your fake fellowship without at all being an expert in regional anesthesia.

Completely agree that the field has become watered down with questionable blocks for questionable indications resulting in questionable efficacy. The RAAPM effect.

This guy will get what is coming to him though. You act like a block jock without thinking and you'll eventually get burned enough times.

Aww

Sounds like someone didnt get enough hugs as a kid. Its ok, just remember, you are good enough, smart enough, and doggone it, people like you!

 

[pgg]

Its ok. Many practices are full of the stubborn old heads. Regional is tough for you guys to learn

I am sure they have some regional training courses that you can sign up for in your area

This clown

It ought to be possible to politely disagree about whether certain blocks are worthwhile for specific indications, without insulting anyone or assuming the other guy is unable, unskilled, or incompetent.

 

[UscGhost]

It ought to be possible to politely disagree about whether certain blocks are worthwhile for specific indications, without insulting anyone or assuming the other guy is unable, unskilled, or incompetent.

He started it!!

And then i started to enjoy getting Maz777 all riled up. If I squint hard enough..i can actually see the veins bulging out of his head

 

[PpfSuxTube]

Well I applaud you sticking to your guns anyways... despite you being massively anti gun...

I wont be doing this anyways, mostly for shame whatever the evidence. My colleagues would think im committing fraud

 

[UscGhost]

Well I applaud you sticking to your guns anyways... despite you being massively anti gun...

I wont be doing this anyways, mostly for shame whatever the evidence. My colleagues would think im committing fraud

Eh. Its a pretty easy procedure to stand by.

Its quick, easy, extremely safe, patients do better and surgeons request them. I dont need it to cure cancer.

It would be much more difficult to defend a routine paravertebral block for example. Technically challenging, higher risk, complications are very problematic, takes much longer, etc. there would need to be a much more significant benefit to warrant it

And yes, local routine practice plays a role, as it does with many aspects of anes

 

[Dantrolene FC]

Link to the news story?

Nah, then I’ll dox myself

 

[UscGhost]

Nah, then I’ll dox myself

Cool. Thanks for the contribution anyway

 

[Maz777]

It ought to be possible to politely disagree about whether certain blocks are worthwhile for specific indications, without insulting anyone or assuming the other guy is unable, unskilled, or incompetent.

Lame. Where is the fun in that?

But seriously, thank you, mom. You are always so wise.

 

[Twiggidy]

Polite question. In this case where you do a TAP for a lap appy are the surgeons not injecting local at the end of the case? Ours routinely inject local in their incisions so I wouldn't do a TAP for them. Otherwise, a TAP is pretty easy and everyone should be able to learn it quickly if a surgeon requests one.

 

[UscGhost]

Polite question. In this case where you do a TAP for a lap appy are the surgeons not injecting local at the end of the case? Ours routinely inject local in their incisions so I wouldn't do a TAP for them. Otherwise, a TAP is pretty easy and everyone should be able to learn it quickly if a surgeon requests one.

Most still do. Some dont. Their local is only a few CCs, so i dont expect much but i encourage it

 

[Twiggidy]

Most still do. Some dont. Their local is only a few CCs, so i dont expect much but i encourage it

Ok. I mean I see nothing wrong with a TAP for a lap appy. You can do it at the end so it’s not slowing things down and again it’s a fairly easy fascial plane block. Our surgeons inject 30 cc of local so in our practice there’s no use for a TAP

 

[coffeebythelake]

Do you guys find the space and inject and give yourself a high five.... or do you inject and walk the needle to spread as out much fascia layer as possible?

 

[AKMD_1984]

Absolutely.

Patient selection is a calculation based on anticipated degree of benefits, cost, and risk of complications

Myelograms are costly, risks are very significant and impactful when they occur (while rare), so the anticipated benefits should scale accordingly.

A tap block takes 3 mins, costs $10 in materials and risks are virtually 0. So if that allows me to reduce opioid use, improve pain scores and reduce anti emetics. Ill take it. I don't need it to cure cancer

That being said..the pain speciality itself is rife with abuse and fraud (not implying that you are doing anything like that)

1. Myelograms are sent to me by neurosurgeons for surgical planning. These are not my patients. I was giving an example that just because we dont do TAPs for appy or chole, it does not mean that we are not capable of putting a needle where its suppose to go. Its just that we do not believe that it is needed. Not every one can do myelograms esp. on patients that have hardware and secondly be willing to manage blood patches. I took over this practice from IR and I am currently filling a need. It is an annoying procedure, but not everything in life is going to be easy.

2. Again, no one would be doing TAPs if they did not get paid for it. The point is - just like how you are justifying the need to perform TAP blocks, I can easily justify why I do not do them. Because it is not a gold standard treatment or has any significantly superior outcome vs NO TAP compelling me to do it. That is based on my experience and review of literature. Cost and ease of procedure is not the only criteria. It is still unnecessary. That is a slippery slope actually. So you are telling me you do them because they a cheap (for you?) and easy - even if they are not indicated? You do not see how this can be unethical?

 

[AKMD_1984]

Opiod spinals for what case?

AI disagrees with you

are nerve blocks considered best practices for post laparoscopic abdominal pain

Yes,
nerve blocks (like TAP & RSB) are increasingly recognized as effective, best-practice components for post-laparoscopic pain management, offering good opioid-sparing relief with fewer side effects, though specific blocks (like RSB) might vary in effectiveness, and evidence quality is still maturing. They're part of a multimodal approach, reducing opioid reliance, but evidence quality can vary,

Couple of questions for you:

1) Are you an academic physician? If so, what is your schedule like? Are you performing your own cases?
2) The example for opioid spinal was a hypothetical one - technically it will work. Why wont it work. Scientifically it should, correct? Perhaps it may be better than TAPs. I do not know nor do I care because it is something I have never done, and will never do. It is not usual practice. But I made that point to show that just because something can be done, does not mean it should be OR ITS THE BEST OPTION. In China, CABGs have been performed with continuous cervical epidurals. Will you do that too?

 

[Southpaw]

I’ve worked with surgeons who ‘do their own TAP blocks’ and they believe it works. It’s a blind shot of local somewhere deep to skin. Oh yeah they also bill separately for it. But if they think that works then why would anyone question the utility of using US to ensure the local lands in the correct area? I don’t do many TAPs these days and have never done one for a lap appy, but I imagine it’d help.

I’ve also done opioid spinals (duramorph) for CS of course but also for longer more invasive abdominal procedures. There’s great utility in this IMO. It’s easily seen if your patients don’t receive the duramorph spinal and you follow them post op or ask the surgeon how they’re doing.

 

[UscGhost]

1. Myelograms are sent to me by neurosurgeons for surgical planning. These are not my patients. I was giving an example that just because we dont do TAPs for appy or chole, it does not mean that we are not capable of putting a needle where its suppose to go. Its just that we do not believe that it is needed. Not every one can do myelograms esp. on patients that have hardware and secondly be willing to manage blood patches. I took over this practice from IR and I am currently filling a need. It is an annoying procedure, but not everything in life is going to be easy.

2. Again, no one would be doing TAPs if they did not get paid for it. The point is - just like how you are justifying the need to perform TAP blocks, I can easily justify why I do not do them. Because it is not a gold standard treatment or has any significantly superior outcome vs NO TAP compelling me to do it. That is based on my experience and review of literature. Cost and ease of procedure is not the only criteria. It is still unnecessary. That is a slippery slope actually. So you are telling me you do them because they a cheap (for you?) and easy - even if they are not indicated? You do not see how this can be unethical?

1. Not indicated?

Transabdominal Plane Block - StatPearls - NCBI Bookshelf

Indications
Providing analgesia after an abdominal wall procedure in various abdominal surgeries is an indication of the TAP block. The TAP block can be performed for open abdominal surgeries and laparoscopic procedures. The block is an easier and less risky substitute for epidural anesthesia in postoperative pain control for abdominal surgeries.

A unilateral block is used for a one-sided procedure, such as appendectomy, cholecystectomy, nephrectomy, and renal transplant.
Bilateral blocks are used for midline and transverse abdominal incisions, such as ventral hernia repair, umbilical hernia repair, exploratory laparotomy, colostomy closure, cesarean delivery, hysterectomy, radical retropubic prostatectomy, bariatric surgery, inguinal hernia repair, and laparoscopic surgery.
TAP blocks can also play a role in chronic pain management.[7][8][9

Certainly listed as an indication.


2. Nobody would do them if they didn't get paid? We do all kinds of procedures regardless of payment. Spinals, rescue blocks, ipack + adductor blocks (insurance only pays for one). Many cases are non insured, medicaid, cash. All get same regimens.

Maybe thats a problem in your area?

3. What significantly superior outcome do you require? What degree of reduction in opiod use, pain scores. Tap blocks have consistently been shown to be superior to local infiltration...so if Tap blocks dont help...then do you tell surgeons they don't need to inject either since there injections are even less effective?

Does the degree of benefit that you require from a TAP correlate with the time, complexity, risk of the procedure? Seems odd, that some of the replies on this thread consist of "who cares if they need a few extra oxycodone or their pain scores are higher"

Not sure what minimum opiod and pain score is required for some folks

 

[UscGhost]

I’ve worked with surgeons who ‘do their own TAP blocks’ and they believe it works. It’s a blind shot of local somewhere deep to skin. Oh yeah they also bill separately for it. But if they think that works then why would anyone question the utility of using US to ensure the local lands in the correct area? I don’t do many TAPs these days and have never done one for a lap appy, but I imagine it’d help.

I’ve also done opioid spinals (duramorph) for CS of course but also for longer more invasive abdominal procedures. There’s great utility in this IMO. It’s easily seen if your patients don’t receive the duramorph spinal and you follow them post op or ask the surgeon how they’re doing.

From my understanding...surgeons cant bill for pain control as its bundled in.

Most of the studies i ran across indicated that US guided were superior to surgeon placed blocks.

Most surgeons inject 3ml per port site. Simply not enough to be effective

 

[UscGhost]

Couple of questions for you:

1) Are you an academic physician? If so, what is your schedule like? Are you performing your own cases?
2) The example for opioid spinal was a hypothetical one - technically it will work. Why wont it work. Scientifically it should, correct? Perhaps it may be better than TAPs. I do not know nor do I care because it is something I have never done, and will never do. It is not usual practice. But I made that point to show that just because something can be done, does not mean it should be OR ITS THE BEST OPTION. In China, CABGs have been performed with continuous cervical epidurals. Will you do that too?

So your argument is that " you dont care if its better or not"

Sounds like evidenced based medicine to me!

 

[Howard888]

We don’t do any extra procedure that isn’t paid one way or another. Insurance, hospital, or patient -except perhaps for an extra IV.

And you keep sighting terrible data on taps. The Cleveland study is way better and that’s what insurance will use to stop
Payment. And they’re correct to not pay for it

 

[UscGhost]

We don’t do any extra procedure that isn’t paid one way or another. Insurance, hospital, or patient -except perhaps for an extra IV.

And you keep sighting terrible data on taps. The Cleveland study is way better and that’s what insurance will use to stop
Payment. And they’re correct to not pay for it

The same author also published a study a couple years prior saying that TAP blocks had similar pain scores, less hypotension, with non clinically relevant higher opiod needs than continuous epidurals for major abdominal surgery. He concluded that TAPS should be considered as an alternative to epidurals for sick patients, or those that need anticoagulation.

Not to mention the fact that a TAP is much less risky, less invasive, less expensive, and far more time consuming vs the "gold standard" epidural

https://www.sciencedirect.com/science/article/abs/pii/S0952818021004839

So, TAP blocks suddenly dont work in 2025 but then they worked basically as well continuous epidurals in 2022? Does that mean that epidurals dont work either?

 

[FiO2@21]

2026 American Society of Anesthesiologists... : Anesthesiology

This practice guideline addresses perioperative pain management using local and regional anesthesia for cardiothoracic, mastectomy, and abdominal...

journals.lww.com

Just to stir the pot a little. For what it's worth the CLEVELAND trial posted earlier seems to be pretty compelling evidence against TAP block use, I did not open the supplements for the above statement to see if that trial was included (probably not). Maybe the studies should start documenting photos of needle placement and ultrasound images.

 

[UscGhost]

2026 American Society of Anesthesiologists... : Anesthesiology

This practice guideline addresses perioperative pain management using local and regional anesthesia for cardiothoracic, mastectomy, and abdominal...

journals.lww.com

Just to stir the pot a little. For what it's worth the CLEVELAND trial posted earlier seems to be pretty compelling evidence against TAP block use, I did not open the supplements for the above statement to see if that trial was included (probably not). Maybe the studies should start documenting photos of needle placement and ultrasound images.

Seems like a very strong statement from the ASA. But what do i know.

"Fascial plane blocks are strongly recommended for adults undergoing open cardiothoracic, mastectomy, abdominal, retroperitoneal, and pelvic surgeries.

Fascial plane blocks are recommended for adults undergoing minimally invasive abdominal procedures.

The Cleveland study is interesting..but i haven't been able to find the actual study to read..only the abstract. the same author also published a study a couple years prior saying TAPs were as almost good as epidurals and a viable alternative.

 

[Maz777]

2026 American Society of Anesthesiologists... : Anesthesiology

This practice guideline addresses perioperative pain management using local and regional anesthesia for cardiothoracic, mastectomy, and abdominal...

journals.lww.com

Just to stir the pot a little. For what it's worth the CLEVELAND trial posted earlier seems to be pretty compelling evidence against TAP block use, I did not open the supplements for the above statement to see if that trial was included (probably not). Maybe the studies should start documenting photos of needle placement and ultrasound images.

That nonsense "publication" is the who's who of ASRAers who have been pushing for garbage fascial plane blocks over the last decade.

Eventually, we will stop doing actual nerve blocks. Everything will be a fascial plane block of questionable efficacy! Rejoice! Fascial plane block of the brachial plexus incoming in 3,2,1...

/sarcasm

 

[UscGhost]

That nonsense "publication" is the who's who of ASRAers who have been pushing for garbage fascial plane blocks over the last decade.

Eventually, we will stop doing actual nerve blocks. Everything will be a fascial plane block of questionable efficacy! Rejoice! Fascial plane block of the brachial plexus incoming in 3,2,1...

/sarcasm

I know. Darn all those highly qualified experts pushing their guidelines on everyone.

If a fascial block doesnt cure cancer...not worth it

 

[Howard888]

It’s not. Have fun doing them for zero money. I’ll be first to back the payers on this

 

[UscGhost]

It’s not. Have fun doing them for zero money. I’ll be first to back the payers on this

Lol.

I guess the ASA taskforce recommending them doesnt make a difference. Some people on here are funny. So your argument is now that the ASA panel of experts is wrong and YOU are right?

" I dont know if they work but even if they do, i still won't do them"
"I won't" t do them because they don't reduce LOS"
" I won't do them even if the ASA recommends them"
" They arent indicated"(reads ASA guidelines that recommends them)" Eh i still wont do them"

Weird

 

[pgg]

[COLOR=rgba(255, 255, 255, 0.6)]Not to mention the fact that a TAP is much less risky, less invasive, less expensive, and far more time consuming vs the "gold standard" epidural[/COLOR]

Epidurals aren't especially risky.

I'll give you the time & cost benefit advantage going to TAPs, but they're certainly not as efficacious as epidurals. Don't know why you put gold standard in quotes - an epidural definitely is. (And it'd be ridiculous for a lap appy too! 🙂)