Ultrasound Blocks for the Anterior Abdominal Wall

3. Transverse Abdominal Plexus Block | 39
Figure 3.3 – Transducer positioning between iliac crest and costal
margin.
Figure 3.4 – Positioning and ultrasound appearance of classical TAPB
procedure.
The needle is inserted and advanced obliquely with an in-plane
approach, parallel and aligned to the long axis of the transducer.
The in-plane approach would possibly decrease the risk of
advancing the needle into the peritoneal cavity. The presence of
blood vessels must be always checked on the screen. Aspiration
before injection is necessary to avoid intravascular placement.
When the fascia between the IOM and the TAM is reached with
the needle, a small volume of local anesthetic may be injected. If
the fascia expands, the needle is placed correctly (Figure 3.6). If
the muscle expands, the needle must be replaced. The whole