Tap, tap, tap....

[ms1inmw]

Is anyone using (TAP) transversus abdominis plane blocks? With/without ultrasound? For what surgeries?

I used them with some success for C-sections in residency.

I am interested in looking for new ways to expand our pain service. A gastric bypass program has started at our hospital; interested if they might be helpful for these folks. Granted they might be a bit more challenging in these folks, but I like the idea (reduced post-op opiod use, improved pain scores, etc.....)

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[sevoflurane]

I would go for a good 'ol fashion epidural in that patient population.

TAP blocks in the morbidly obese without USD has a low success rate. Even if you do get 20cc's on ea. side (with USD), the comparitive analgesia is nowhere close to a well placed epidural.

Great for stat C/S that don't have an epidural on board or the 4 inch midline incision that does not need an epidural.

I'm all for TAP blocks btw.

 

[Gimlet]

Saw our regional team do one for a groin exploration/sports hernia repair. Worked pretty slick.

 

[B-Bone]

Always do them under US. I've done a few for open appys or inguinal hernias (if the surgeons want GETA, which is rare). I've also done them after stat c/s under GETA or c/s under spinal for people I don't want to give duramorph to (i.e. huge fatties, OSA, morphine allergy, etc). All of these situations are pretty rare, though, so I don't do a lot of them. Pain control is good, usually hangs around 12-16 hours using 0.25% bupi with epi. Not the most useful block around, but comes in handy occasionally. Other block I picked up on at a meeting is the bilateral rectus sheath block for midline incisions. Really easy to do, esp in larger folks.

 

[Idiopathic]

we stopped doing them after c-section when we had two seizures in the span of about 6 months.

 

[dhb]

Going between 2 fascias without ultrasound is pretty hard to do.
I think it's a great block to do: the last laparotomies i've done had used 10mg of morphine after 48h.

 

[HalO'Thane]

I'm a peds guy working at a children's hospital. I do them a lot for inguinal hernias and lower abdominal incisions in patients that would be too big for a caudal. Given my patient population, they are usually done after the patient is asleep under ultrasound guidance. The NYSORA website has a great description of this. I have also started using bilateral rectus sheath blocks for midline incisions with some success.

 

[deleted9493]

I am a big fan of the rectus sheath block. The fascial planes seem easier to delineate compared to the views I've seen in TAP approaches. Both seem pretty high yield for the amount of time/risk incurred placing these...at least in my own pediatrics experience.

 

[G0S2]

Just used it for a donor nephrectomy and it appeared to work well. Used US and 0.5% Ropivicaine.

 

[HalO'Thane]

Just used it for a donor nephrectomy and it appeared to work well. Used US and 0.5% Ropivicaine.

Did you use the standard approach at the triangle of petit (above the iliac crest) or a higher subcostal approach for your block? I always thought the peak dermatome level of a standard TAP block was T10 - T12 and therefore wouldn't be high enough for a nephrectomy incision

 

[G0S2]

Did you use the standard approach at the triangle of petit (above the iliac crest) or a higher subcostal approach for your block? I always thought the peak dermatome level of a standard TAP block was T10 - T12 and therefore wouldn't be high enough for a nephrectomy incision

I should qualify and state laparoscopic nephrectomy. The T10-T12 dermatome was covered and that is where the trochars were inserted.