Transversus abdominis plane block: a cadaveric and radiological evaluation.
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Authors
McDonnell, John GO'Donnell, Brian D
Farrell, Thomas
Gough, Niall
Tuite, David
Power, Camillus
Laffey, John G
Affiliation
Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Tallaght, Dublin, Ireland.Issue Date
2011-04-11T10:14:32ZMeSH
Abdominal WallAdult
Anesthetics, Local
Cadaver
Humans
Lidocaine
Magnetic Resonance Imaging
Male
Methylene Blue
Nerve Block
Tomography, X-Ray Computed
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Transversus abdominis plane block: a cadaveric and radiological evaluation., 32 (5):399-404 Reg Anesth Pain MedJournal
Regional anesthesia and pain medicineDOI
10.1016/j.rapm.2007.03.011PubMed ID
17961838Abstract
The abdominal wall is a significant source of pain after abdominal surgery. Anterior abdominal wall analgesia may assist in improving postoperative analgesia. We have recently described a novel approach to block the abdominal wall neural afferents via the bilateral lumbar triangles of Petit, which we have termed a transversus abdominis plane block. The clinical efficacy of the transversus abdominis plane block has recently been demonstrated in a randomized controlled clinical trial of adults undergoing abdominal surgery.After institutional review board approval, anatomic studies were conducted to determine the deposition and spread of methylene blue injected into the transversus abdominis plane via the triangles of Petit. Computerized tomographic and magnetic resonance imaging studies were then conducted in volunteers to ascertain the deposition and time course of spread of solution within the transversus abdominis fascial plane in vivo.
Cadaveric studies demonstrated that the injection of methylene blue via the triangle of Petit using the "double pop" technique results in reliable deposition into the transversus abdominis plane. In volunteers, the injection of local anesthetic and contrast produced a reliable sensory block, and demonstrated deposition throughout the transversus abdominis plane. The sensory block produced by lidocaine 0.5% extended from T7 to L1, and receded over 4 to 6 hours, and this finding was supported by magnetic resonance imaging studies that showed a gradual reduction in contrast in the transversus abdominis plane over time.
These findings define the anatomic characteristics of the transversus abdominis plane block, and underline the clinical potential of this novel block.
Item Type
ArticleLanguage
enISSN
1098-7339ae974a485f413a2113503eed53cd6c53
10.1016/j.rapm.2007.03.011
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