Ultrasound-guided abdominal wall nerve blocks in the ED

The anterolateral abdominal wall is innervated by the T7 to L1 anterior rami, whose nerves travel in the fascial plane between the internal oblique and transversus abdominus muscles, known as the transversus abdominus plane (TAP). Ultrasound-guided techniques of regional anesthesia that target the TAP are increasingly relied upon by anesthesiologists for pain management related to major abdominal and gynecologic surgeries. Our objective was to explore the potential utility of these techniques to provide anesthesia for abdominal wall procedures in the emergency department (ED).

We conducted a prospective, cross-sectional, descriptive case series of ultrasound-guided abdominal wall nerve blocks performed by emergency physicians in the ED.

Between July 1 and September 1, 2010, 4 patients were selected for an ultrasound-guided TAP nerve block or an ilioinguinal/iliohypogastric nerve block. Three patients presented with soft tissue abscesses on the anterior abdomen, and 1 patient presented with postoperative pain and swelling after hernia surgery. Patients were aged 35 to 50 years. Mean time to complete the procedures was 8.5 minutes. All blocks resulted in complete surgical anesthesia sufficient for comfortable incision and drainage or needle aspiration without the need for additional analgesia or sedation. There were no complications.

In a series of 4 ED patients, ultrasound-guided TAP and ilioinguinal/iliohypogastric blocks performed by emergency physicians provided excellent procedural anesthesia. Further study of these techniques as an alternative to sedation for ED patients undergoing abdominal wall procedures is warranted.