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<br /> Ultrasound<br /> Ultrasound-guided Transversus<br /> Abdominis Plane (TAP) block<br /> Philips tutorial<br /> Francis V. Salinas, MD<br /> Staff Anesthesiologist and Section Head of Orthopedic Anesthesia<br /> Coordinator of Ultrasound-Guided Regional Anesthesia Education<br /> Virginia Mason Medical Center, Seattle, WA<br /> Contents<br /> Ultrasound-guided Transversus Abdominis<br /> Plane (TAP) block<br /> 1 Introduction 3<br /> 2 Indications 6<br /> 3 Clinical anatomy 8<br /> 4 Ultrasound anatomy and technique 17<br /> 5 Clinical pearls and tips 41<br /> 6 References 44<br /> Additional resources 46<br /> 2 Contents<br /> 1 Introduction<br /> The sensorimotor innervation of the anterior abdominal<br /> wall is <a title="Philips TAP Block Guide page 1" href="http://viewer.zmags.com/publication/6aa8b9ad?page=1"> Ultrasound Ultrasound-guided Transversus Abdomin</a> <a title="Philips TAP Block Guide page 2" href="http://viewer.zmags.com/publication/6aa8b9ad?page=2"> Contents Ultrasound-guided Transversus Abdomin</a> <a title="Philips TAP Block Guide page 3" href="http://viewer.zmags.com/publication/6aa8b9ad?page=3"> 1 Introduction The sensorimotor innerva</a> <a title="Philips TAP Block Guide page 4" href="http://viewer.zmags.com/publication/6aa8b9ad?page=4"> After localization of the triangle of Petit by pa</a> <a title="Philips TAP Block Guide page 5" href="http://viewer.zmags.com/publication/6aa8b9ad?page=5"> Thus, reliable localization of the triangle of Pe</a> <a title="Philips TAP Block Guide page 6" href="http://viewer.zmags.com/publication/6aa8b9ad?page=6"> 2 Indications The TAP block is a relative</a> <a title="Philips TAP Block Guide page 7" href="http://viewer.zmags.com/publication/6aa8b9ad?page=7"> Although the majority of case series and randomiz</a> <a title="Philips TAP Block Guide page 8" href="http://viewer.zmags.com/publication/6aa8b9ad?page=8"> 3 Clinical anatomy The layers of the ante</a> <a title="Philips TAP Block Guide page 9" href="http://viewer.zmags.com/publication/6aa8b9ad?page=9"> Anterior cutaneous branch Lateral cutaneous bran</a> <a title="Philips TAP Block Guide page 10" href="http://viewer.zmags.com/publication/6aa8b9ad?page=10"> As the anterolateral muscles course medially towa</a> <a title="Philips TAP Block Guide page 11" href="http://viewer.zmags.com/publication/6aa8b9ad?page=11"> [Figure 1c] Axial and coronal CT scan of the abdo</a> <a title="Philips TAP Block Guide page 12" href="http://viewer.zmags.com/publication/6aa8b9ad?page=12"> The thoracolumbar nerves course through the anter</a> <a title="Philips TAP Block Guide page 13" href="http://viewer.zmags.com/publication/6aa8b9ad?page=13"> Transversus abdominis Internal oblique Rectus a</a> <a title="Philips TAP Block Guide page 14" href="http://viewer.zmags.com/publication/6aa8b9ad?page=14"> [Figure 2b] Segmental cutaneous dermatomes of the</a> <a title="Philips TAP Block Guide page 15" href="http://viewer.zmags.com/publication/6aa8b9ad?page=15"> A series of cadaveric and dye injectate studies h</a> <a title="Philips TAP Block Guide page 16" href="http://viewer.zmags.com/publication/6aa8b9ad?page=16"> 5. There is extensive branching and communicatio</a> <a title="Philips TAP Block Guide page 17" href="http://viewer.zmags.com/publication/6aa8b9ad?page=17"> 4 Ultrasound anatomy and technique Post</a> <a title="Philips TAP Block Guide page 18" href="http://viewer.zmags.com/publication/6aa8b9ad?page=18"> [Figure 3a and 3b] The patient is supine. Note th</a> <a title="Philips TAP Block Guide page 19" href="http://viewer.zmags.com/publication/6aa8b9ad?page=19"> Ultrasound anatomy and technique 19</a> <a title="Philips TAP Block Guide page 20" href="http://viewer.zmags.com/publication/6aa8b9ad?page=20"> [Figure 4] 2D sonoanatomy of the ultrasound-guide</a> <a title="Philips TAP Block Guide page 21" href="http://viewer.zmags.com/publication/6aa8b9ad?page=21"> –There will be a layer of subcutaneous tissue and</a> <a title="Philips TAP Block Guide page 22" href="http://viewer.zmags.com/publication/6aa8b9ad?page=22"> [ Video 1] The 3 layers</a> <a title="Philips TAP Block Guide page 23" href="http://viewer.zmags.com/publication/6aa8b9ad?page=23"> • After the optimal image is obtained, a 20- or 2</a> <a title="Philips TAP Block Guide page 24" href="http://viewer.zmags.com/publication/6aa8b9ad?page=24"> [Figure 5b and 5c] Posterior TAP block with the a</a> <a title="Philips TAP Block Guide page 25" href="http://viewer.zmags.com/publication/6aa8b9ad?page=25"> –The needle direction is from anterior to posteri</a> <a title="Philips TAP Block Guide page 26" href="http://viewer.zmags.com/publication/6aa8b9ad?page=26"> [Figure 6] 2D sonoanatomy of the correct needle-t</a> <a title="Philips TAP Block Guide page 27" href="http://viewer.zmags.com/publication/6aa8b9ad?page=27"> –After correct local anesthetic distribution is c</a> <a title="Philips TAP Block Guide page 28" href="http://viewer.zmags.com/publication/6aa8b9ad?page=28"> [Figure 7a] 2D sonoanatomy of the posterior TAP c</a> <a title="Philips TAP Block Guide page 29" href="http://viewer.zmags.com/publication/6aa8b9ad?page=29"> [Figure 7b] 2D sonoanatomy of the posterior TAP c</a> <a title="Philips TAP Block Guide page 30" href="http://viewer.zmags.com/publication/6aa8b9ad?page=30"> [ Video 2] Technique (t</a> <a title="Philips TAP Block Guide page 31" href="http://viewer.zmags.com/publication/6aa8b9ad?page=31"> [ Video 3] Another exam</a> <a title="Philips TAP Block Guide page 32" href="http://viewer.zmags.com/publication/6aa8b9ad?page=32"> If a catheter technique is desired, a 17-gauge 90</a> <a title="Philips TAP Block Guide page 33" href="http://viewer.zmags.com/publication/6aa8b9ad?page=33"> [Figure 8] TAP catheter secured to the skin after</a> <a title="Philips TAP Block Guide page 34" href="http://viewer.zmags.com/publication/6aa8b9ad?page=34"> [ Video 4] Ultrasound-g</a> <a title="Philips TAP Block Guide page 35" href="http://viewer.zmags.com/publication/6aa8b9ad?page=35"> Sub-costal TAP approach • The patient is supine w</a> <a title="Philips TAP Block Guide page 36" href="http://viewer.zmags.com/publication/6aa8b9ad?page=36"> • Identify the layers of the lateral abdominal wa</a> <a title="Philips TAP Block Guide page 37" href="http://viewer.zmags.com/publication/6aa8b9ad?page=37"> – At the lateral (and deeper) part of the ultraso</a> <a title="Philips TAP Block Guide page 38" href="http://viewer.zmags.com/publication/6aa8b9ad?page=38"> – The needle is advanced and observed penetrating</a> <a title="Philips TAP Block Guide page 39" href="http://viewer.zmags.com/publication/6aa8b9ad?page=39"> – After correct local anesthetic distribution is </a> <a title="Philips TAP Block Guide page 40" href="http://viewer.zmags.com/publication/6aa8b9ad?page=40"> [ Video 5] Ultrasound-g</a> <a title="Philips TAP Block Guide page 41" href="http://viewer.zmags.com/publication/6aa8b9ad?page=41"> 5 Clinical pearls and tips • The ultrasound-</a> <a title="Philips TAP Block Guide page 42" href="http://viewer.zmags.com/publication/6aa8b9ad?page=42"> Local anesthetic selection • For single injection</a> <a title="Philips TAP Block Guide page 43" href="http://viewer.zmags.com/publication/6aa8b9ad?page=43"> • TAP blocks do not provide complete anesthesia-a</a> <a title="Philips TAP Block Guide page 44" href="http://viewer.zmags.com/publication/6aa8b9ad?page=44"> 6 References Monographs 1. Salinas FV. How I </a> <a title="Philips TAP Block Guide page 45" href="http://viewer.zmags.com/publication/6aa8b9ad?page=45"> Case series – reports, editorials and letters to </a> <a title="Philips TAP Block Guide page 46" href="http://viewer.zmags.com/publication/6aa8b9ad?page=46"> Additional resources For additional resources</a> <a title="Philips TAP Block Guide page 47" href="http://viewer.zmags.com/publication/6aa8b9ad?page=47"> This paper reflects the opinion of the author, no</a>