Who's doing TAP and ilioinguinal/hypogastric blocks?

[sevoflurane]

With ultrasound guided regional anesthesia the success rate of these blocks is much higher. Are these backburner regional techniques or are you using them regularly?

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[countingdays]

With ultrasound guided regional anesthesia the success rate of these blocks is much higher. Are these backburner regional techniques or are you using them regularly?

We do them fairly frequently.

 

[smgilles]

With ultrasound guided regional anesthesia the success rate of these blocks is much higher. Are these backburner regional techniques or are you using them regularly?

Regularly.

 

[urge]

We do them fairly frequently.

For what kind of procedures?

Awake or asleep?

Kids or adults?

Do these procedures hurt that much or do you do them because you can?

 

[dhb]

I've been trying this year but i've not been impressed with the results. Maybe i'm putting the local in between the wrong fascias: sometimes i feel like i have 4 layers of muscle instead of 3...

 

[urge]

I've been trying this year but i've not been impressed with the results. Maybe i'm putting the local in between the wrong fascias: sometimes i feel like i have 4 layers of muscle instead of 3...

I wonder how many intraperitoneal injections you have done.

 

[sevoflurane]

For what kind of procedures?

Awake or asleep?

Kids or adults?

Do these procedures hurt that much or do you do them because you can?

Any lower abdominal procedure. Inguinal hernias, umbilical hernias, abdominal hernias that are too small to justify epidural placement, appy, abd wall tumor resections, hysterectomies. Post op pain control for crash c/s that don't have epidurals in place and moms who don't want to be sedated during the first hours of their new ones life- bilateral catheter placement have been used succesfully. Recently had a lap chole go open in a pulmonary cripple: TAP 20 cc's of LA . Total fentanyl for the case = 50 mcgs on induction. No narcs post-op. Good respiratory effort.

asleep or awake... I prefer asleep with USD.

kids and adults.

General:
http://www.anesthesia-analgesia.org/content/104/1/193.full

C-sections:
http://www.anesthesia-analgesia.org/content/106/1/186.full

Pediatrics:
http://www.anesthesia-analgesia.org...ract?sid=cdb88572-1df5-40b5-916a-d35de066c5ee

By no means will you achieve the kind of pain control that you get with spinals or epidurals. But they are an effective way of providing analgesia and another tool to call on if you were to need it- particularly in an era where prescription narcotics have become a serious problem in our patients. I would never do these if I did not have an USD available to me. It is also another way to differentiate me from a CRNA.

If you have an USD available to you, I'd at least check it out. It is very hard to violate the peritonium under direct vision. It is a low risk procedure.

 

[dhb]

I wonder how many intraperitoneal injections you have done.

None

 

[Jay K]

None.

 

[sifidawkins]

At Maine med we do them for tah/bso. They seem to work well. I've Had multiple patients go from whincing in pain (we do them post op) to asleep after first side is done and prepping for the other.

 

[soorg]

Have done about 5, plan to do more in the future. Of the 3 that worked (for open appendectomies), it was great. Pts. were pain free for 24 hours post-op. One didn't work (first one I had ever done), and one partially worked. Used USG for all, done after induction. It seems that since the sensory afferents for the anterior abdominal wall are so small, the risk of intraneural injection is slim.