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Transversus abdominis plane (TAP) block is a novel type of peripheral nerve block that involves innervations of the anterolateral abdominal wall derived from T6-L1.It provides adequate post-operative pain relieve following the various abdominal surgeries. Theoretically, TAP block may replace the need for epidural analgesia after abdominal operations. The oblique subcostal approach of the TAP (OSTAP) block, which was de¬scribed by (Hebbard et al, 2010) , has been reported to provide analgesia to the entire anterior abdomen.
The transversus abdominis plane (TAP) technique, originally described by (Rafi, 2001) involves injection of local anaesthetic in the plane between the internal oblique and transversus abdominis muscle layers, with the aim of anaesthetising the intercostal nerves supplying the abdominal wall. Initially, the block used surface landmarks of the triangle of Petit (latissimus dorsi posteriorly, external oblique superiorly, iliac crest inferiorly) and a double fascial 'pop' (loss of resistance) to guide placement of the local anaesthetic (Rafi, 2001) More recently, ultrasonography has been used to guide the delivery of the injectate into the appropriate plane, thereby increasing the accuracy of the technique (Bonnet et al, 2009, Carney et al ,2008, McDonnel et al,2008 ,Milan et al ,2011, Niraj et al, 2011). However, in some reports the safety of TAP blocks has been raised. . (Jankovic et al, 2008) There have also been reports of liver injury caused by needle damage.(Farooq et al,2008, Lancaster et al,2010) Theoretical concerns have also been discussed regarding the risk of femoral nerve palsy.( Walker et al , 2010, Rosario, et al 1997). Landmark techniques and utrasonography guided placement of TAP blocks may also be more difficult in obese patients needs experience and may be not available in certain areas.
Recently, surgically administered TAP blocks have been described, allowing a more accurate placement (Owen et al, 2014, Araco et al 2010, Bharti et al 2011).
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Treatment
Bupivacaine 0.25% 20ml on each side Sonar guided TAB, bupivacaine 0.25% 20ml on each side Surgical TAB, Ultrasound
Hala Saad Abdel-Ghaffar
Published on BioPortfolio: 2016-11-30T15:45:24-0500
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A widely used local anesthetic agent.
A local anesthetic with rapid onset and long action, similar to BUPIVACAINE.
A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine.
A local anesthetic that is chemically related to BUPIVACAINE but pharmacologically related to LIDOCAINE. It is indicated for infiltration, nerve block, and epidural anesthesia. Mepivacaine is effective topically only in large doses and therefore should not be used by this route. (From AMA Drug Evaluations, 1994, p168)
Surgical union or shunt between ducts, tubes or vessels. It may be end-to-end, end-to-side, side-to-end, or side-to-side.