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This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract The transversus abdominis plane TAP block is a relatively new regional anesthesia technique that provides analgesia to the parietal peritoneum as well as the skin and muscles of the anterior abdominal wall.
It has a high margin of safety and is technically simple to perform, especially under ultrasound guidance. A growing body of evidence supports the use of TAP blocks for a variety of abdominal procedures, yet, widespread adoption of Anesthesiology term paper therapeutic adjunct has been slow.
In part, this may be related to the limited sources for anesthesiologists to develop an appreciation for its sound anatomical basis and the versatility of its clinical application. As such, we provide a brief historical perspective on the TAP block, describe relevant anatomy, review current techniques, discuss pharmacologic considerations, and summarize the existing literature regarding its clinical utility with an emphasis on recently published studies that have not been included in other systematic reviews or meta-analyses.
Introduction The transversus abdominis plane TAP block is a regional anesthesia technique that provides analgesia to the parietal peritoneum as well as the skin and muscles of the anterior abdominal wall [ 1 ].
First described just a decade ago, it has undergone several modifications, which have highlighted its potential utility for an increasing array of surgical procedures [ 2 ]. Despite a relatively low risk of complications and a high success rate using modern techniques, TAP blocks remain overwhelmingly underutilized [ 3 ].
Although the block is technically straightforward, there is inertia regarding its adoption into clinical practice. In part, this may be related to limited sources for anesthesiologists to develop a comprehensive understanding of the transversus abdominis plane.
As such, we provide a brief historical perspective on the TAP block, describe relevant anatomy, review current techniques, discuss pharmacologic considerations, and summarize the existing literature regarding its clinical utility.
History Rafi first described the TAP block in [ 2 ].
He portrayed it as a refined abdominal field block, with a targeted single shot anesthetic delivery into the TAP, a site traversed by relevant nerve branches. This was a significant advance from earlier strategies that required multiple injections [ 4 ].
In this approach, utilizing surface anatomical landmarks, the TAP was reached by first identifying the lumbar triangle of Petit Figure 1an area enclosed medially by the external oblique, posteriorly by the latissimus dorsi, and inferiorly by the iliac crest [ 2 ].
This sensation was thought to indicate proper needle depth for anesthetic delivery. InMcDonnell et al.
Although referred to as the regional abdominal field infiltration RAFI technique, the authors brought forward preliminary evidence to support the anatomical basis for TAP blocks and demonstrated sensory loss spanning the xiphoid to the pubic symphysis following delivery of local anesthetic to the TAP via the triangle of Petit.
By the time the study was completed and published inMcDonnell and his colleagues had already adopted the term TAP block and had demonstrated its analgesic utility in patients undergoing open retropubic prostatectomy [ 6 — 8 ].
Surface anatomical landmarks can be utilized to identify the triangle of Petit [ 9 ]. Anatomy The musculature of the lateral abdomen has three layers Figure 2. From superficial to deep, they are the external oblique, the internal oblique, and the transversus abdominis muscles.
On its course from medial to lateral, the internal oblique muscle slopes upward and creates a small gap above the iliac crest. It is this sloping edge, above the iliac crest, that defines the medial aspect of the lumbar triangle of Petit Figure 1.
Based on cadaveric dissections, Jankovic et al. The posterior edge of the triangle is the latissimus dorsi muscle. It is not uncommon for the triangle to be quite small or poorly defined.
Often, the external oblique may overlap the medial edge of the latissimus dorsi muscle. The inferior aspect of the triangle is the iliac crest, and the peritoneum rests directly deep to the innermost muscle.
The TAP is the fascial layer between the internal oblique and the transversus abdominis muscles. It exists as a continuous plane located at any point on the abdomen where the two innermost muscle layers exist. Anterior rami of thoracolumbar nerves that innervate the anterior abdominal wall pass through this plane as small, but well-defined neurovascular bundles.
Furthermore, Rozen et al. They also observed that, while nerve segments from T6-L1 reliably innervate the abdominal wall, individual nerve segments branch and communicate extensively with other nerve segments as they travel in the TAP.
Moreover, they noted that nerve segments entered the TAP from the costal margin in an inferolateral distribution such that segments from T6 entered adjacent to the linea alba whereas segments from T9 entered near the anterior axillary line Figure 3.Delegation strategies for the NCLEX, Prioritization for the NCLEX, Infection Control for the NCLEX, FREE resources for the NCLEX, FREE NCLEX Quizzes for the NCLEX, FREE NCLEX exams for the NCLEX, Failed the NCLEX - Help is here.
Recent Examples on the Web. But late-term, third-trimester abortions must be performed in hospitals that have anesthesiology and obstetrics departments. — Christopher Keating, caninariojana.com, "What Would Overturning Roe V. Wade Mean For Abortion Access In Connecticut?," 11 July In the years since, Carlisle applied the same kind of sleuthing to reports beyond anesthesiology.
May 17, · DURHAM, N.C. — IN virtually every field of medicine, black patients as a group fare the worst. This was one of my first and most painful lessons as a medical student nearly 20 years ago.
Daniel J Klionsky University of Michigan, Department of Molecular, Cellular, and Developmental Biology, Ann Arbor, MI, USA; University of Michigan, Life Sciences Institute, Ann Arbor, MI, USA Correspondence [email protected], Kotb Abdelmohsen National Institute on Aging, National Institutes of Health, Biomedical Research Center, RNA Regulation Section, Laboratory of Genetics, Baltimore, MD.
Dec 15, · “My gut feeling is lives are in danger,” said Dr. Papadakos, who recently published an article on “electronic distraction” in Anesthesiology News, a journal.“We’re not educating people.
Emergency Drugs in Anesthesiology and Critical Care Medicine. David Oeser, Pharm. D. Joseph Varon, M.D. Department of Anesthesiology and Critical Care.