<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>