- Regional Anesthesia & Pain Management
- Minimal Invasive Surgery
TAP block, rectus sheath block, ilioinguinal and iliohypogastric nerve block
Unilateral Blocks for:
- Appendix removal
- Hernia operations
(supported by block of the nervus genito femoralis)
- Caesarean section
Bilateral blocks for:
- Midline incisions
- Laparoscopic operations
These techniques form an integral part of the multi-modal anaesthesia concept.
The performance of the TAP-block under ultrasound monitoring
Determination of the initial point of the TAP-block by means of tactile technique.
To perform a TAP block under ultrasound monitoring, the transducer is positioned perpendicular to the abdominal wall – along the centreline between the lower costal arch and the pelvic crest. The skin, subcutaneous tissue, fat, the external oblique muscle of the abdomen, the internal oblique muscle of the abdomen, and the transverse abdominal muscle may be identified on the ultrasound image. The peritoneum and intestinal loops are visible in a layer below the muscle cords.
The cannula is introduced at the plane of the ultrasound probe directly under the transducer and is advanced forward until it has reached the plane between the internal oblique muscle and the transverse abdominal muscle. Saline solution is administered as soon as the plane has been reached, to ensure the correct position of the cannula. The injection will render the course of enlargement of the plane of the transverse abdominal muscle visible(it will appear as a hypoechoic space).
If analgesia is required beyond the duration of single shot regional anaesthesia, then a catheter may be introduced into the oblique abdominal wall by way of a Tuohy cannula. After the enlargement of the plane with saline solution, the catheter is positioned beyond the tip of the cannula. This position is verified by the injection of the local anaesthetic.