Ultrasound Blocks for the Anterior Abdominal Wall

80 | Ultrasound Blocks for the Anterior Abdominal Wall
pain scores and less analgesic consumption for 6 hours
(Courrèges 1996). The reduced pain and postoperative morphine
consumption effects of ultrasound-guided TAPB in
appendicectomy may last for 24 hours (Niraj 2009 (2)). TAPB for
laparoscopic appendicectomy in children has been shown to
offer no important clinical benefit over local anesthetic port-site
infiltration (Sandeman 2011).
Bilateral IIB or TAPB has been reported to be effective for pain
control in retropubic prostatectomy and femoral artery
cannulation at the level of groin (O’Donnell 2006, Serpetinis
2008). Ultrasound-guided TAPB has also been evaluated in
patients scheduled for major orthopedic surgery and anterior
iliac crest harvest for autologous bone graft, with pain abolished
for the first 48 hours (Chiono 2010).
Upper Abdominal Surgery
TAPB is an effective method of blocking the sensory afferents
supplying the anterior abdominal wall. However, the classical
TAPB may not reliably produce analgesia above the umbilicus
(Shibata 2007). The subcostal TAPB involves injection
immediately inferior to the costal margin. It has been reported
to provide analgesia for incisions extending above the umbilicus
(Hebbard 2008). A further development of the subcostal TAPB is
the possibility to place a catheter along the oblique subcostal
line in the TAM plane for continuous infusion of local anesthetic
(Niraj 2011, Hebbard 2010). An ultrasound-guided technique with
a Tuohy epidural needle and catheter may be used in this case.
Bowel surgery
TAPB in adults undergoing large bowel resection via a midline
abdominal incision resulted in a significant reduction of pain
scores and morphine requirements for the first 24 postoperative
hours (21.9 ± 8.9 mg vs. 80.4 ± 19.2 mg) (McDonnell 2007 (2)).