TAP BLOCK - Crash course with Dr. Hadzic

Summary

This video provides an in-depth exploration of the lateral transversus abdominis plane (TAP) block, a key regional anesthesia technique. The video details the process of performing the lateral TAP block using ultrasound guidance, with a focus on the anatomical layers involved, including the external oblique, internal oblique, and transversus abdominis muscles. It also explains the advantages of in-plane versus out-of-plane needle insertion, especially in larger patients. Through a combination of ultrasound images and 3D anatomy dissections, viewers gain a clear understanding of the technique’s application, making it an accessible and effective approach for clinical practice.

Takeaways

• 😀 The TAP block is a regional anesthesia technique used to manage pain during abdominal surgeries by injecting local anesthetic between two muscle layers.
• 😀 The procedure targets the space between the internal oblique and transversus abdominis muscles, where the intercostal nerves are located.
• 😀 The lateral TAP block is one of the simplest and most common variations, providing effective pain relief for many abdominal surgeries.
• 😀 Ultrasound guidance is crucial for visualizing the abdominal wall layers, including the external oblique, internal oblique, and transversus abdominis muscles.
• 😀 The needle is typically inserted in the mid-axillary line, and the procedure may involve either an in-plane or out-of-plane approach, depending on patient size.
• 😀 20-25 mL of local anesthetic is injected between the internal oblique and transversus abdominis muscles to block the sensory nerves effectively.
• 😀 Clinicians should aim to align the muscles horizontally during ultrasound scanning, which ensures clear imaging and precise needle placement.
• 😀 The use of ultrasound animations helps clinicians understand and memorize the anatomical patterns seen during the TAP block procedure.
• 😀 A careful approach to needle insertion can make the TAP block easier and more efficient, particularly in larger patients where an out-of-plane approach may be better.
• 😀 The lateral TAP block is suitable for a variety of abdominal surgeries such as appendectomies, cesarean sections, and costal meatal surgeries.
• 😀 Understanding the anatomical layers and their relationships, including the external oblique, internal oblique, transversus abdominis, and the parietal peritoneum, is key for successful TAP block execution.

Q & A

What is the main focus of the video presented on nysoralms.com?

The main focus of the video is on regional anesthesia, specifically discussing the technique of the transversus abdominis plane (TAP) block and its variants.

What is a key complication when performing the TAP block?

The key complication in performing the TAP block is the confusion caused by its variants, such as the subcostal, lateral, and posterior approaches.

How does the Nisora’s LMS community contribute to the learning process?

Nisora’s LMS community allows members to upload their own ultrasound images, share cases, and participate in relevant discussions, enhancing the learning experience through shared knowledge and clinical practice.

What are the basic anatomical layers involved in the lateral TAP block?

The basic anatomical layers involved in the lateral TAP block include the external oblique muscle, internal oblique muscle, transversus abdominis muscle, and the parietal peritoneum.

Why is the lateral approach to the TAP block often chosen for procedures like appendectomy?

The lateral approach to the TAP block is chosen because it effectively targets the area between the internal oblique and transversus abdominis muscles, providing sufficient anesthesia for procedures like appendectomy.

What is the purpose of the ultrasound animation used in the video?

The ultrasound animation helps viewers visualize the anatomical layers in the TAP block, reinforcing the relationship between the ultrasound images and anatomical structures to facilitate better memorization and understanding.

How does probe manipulation (such as 'healing') affect the quality of the TAP block image?

Using the 'healing' or probe maneuver helps align the muscles horizontally, which improves the quality of the ultrasound image. Without this maneuver, the muscles may appear slanted and harder to identify clearly.

What are the advantages of using an out-of-plane technique in larger patients?

In larger patients, the out-of-plane technique is preferred because it provides a shorter path for the needle to reach the target area between the internal oblique and transversus abdominis muscles, making the procedure easier.

What is the role of local anesthetic in the TAP block, and where is it injected?

Local anesthetic is injected between the fascia of the internal oblique and transversus abdominis muscles, where the anterior rami of the intercostal nerves are located, effectively blocking the sensory nerves in the region.

Why is it important to understand the different approaches to the TAP block?

Understanding the different approaches to the TAP block (subcostal, lateral, and posterior) is crucial because it allows clinicians to choose the most appropriate technique based on the patient's anatomy and the surgical procedure being performed.