Ultrasound Blocks for the Anterior Abdominal Wall

6. Rectus Sheath Block | 63
Table 6.1 – Technical aspects of the abdominal blocks.
Needle 25-22 G,
35-90 mm,
with or
without
injection line
Transducer Linear 10-20
mHz
Technique LOX /
In-plane
Local
anesthetic
volume
IIB TAPB RSB GFB/Inguinal
canal
10 ml each
side
25-22 G,
35-90 mm,
with or
without
injection line
Linear 10-20
mHz
LOX /
In-plane
10-30 ml each
side
25-22 G,
35-90 mm,
with or
without
injection line
Linear 10-20
mHz
LOX /
In-plane
10-30 ml each
side
25-22 G,
35-90 mm,
with or
without
injection line
Linear 10-20
mHz
LOX /
In-plane
10-20 ml each
side
Some important conclusions on the abdominal blocks can be
drawn on the basis of the anatomical data which are confirmed
by several clinical studies.
1. Landmark techniques may be unclear and inaccurate for
positioning the needle tip near the nerves. Moreover they carry
a high risk of complications.
2. Ultrasound techniques provide direct visualization and give
better results in terms of block efficacy, local anesthetic dose
reduction and incidence of complications.
3. The visceral peritoneum, the abdominal organs and testis
will not be blocked with TAPB, IIB, RSB and gGFB. Abdominal
blocks are only one component of a multimodal analgesic
technique and supplemental analgesia with non-steroidal or
opiate analgesics is necessary.
4. The classical TAPB is indicated for procedures involving L1
to T10 extent. Subcostal TAPB is indicated for procedures
involving T12 to T8 extent.
5. Although the classical TAPB is effective for IIB, a selective
IIB is recommended because lower doses of local anesthetic are
required.