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Should we stop doing blind transversus abdominis plane blocks?

G McDermott1, E Korba, U Mata

  • 1Department of Anaesthesia, St Vincent' s University Hospital, Dublin, Ireland. grainne_mcdermott@hotmail.com

British Journal of Anaesthesia
|January 13, 2012
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Summary
This summary is machine-generated.

Landmark-based transversus abdominis plane (TAP) blocks show poor accuracy. Ultrasound revealed a high rate of incorrect needle placement, with frequent peritoneal injections, questioning the safety of this blind technique.

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Area of Science:

  • Anesthesiology
  • Regional Anesthesia
  • Surgical Procedures

Background:

  • Landmark-based regional anesthesia techniques face challenges with needle placement accuracy and potential damage to adjacent structures.
  • The transversus abdominis plane (TAP) block is a regional anesthetic technique used in general surgery.
  • Evaluating the accuracy of landmark-based TAP blocks is crucial for patient safety.

Purpose of the Study:

  • To evaluate the accuracy of needle tip and local anesthetic placement during landmark-based transversus abdominis plane (TAP) blocks.
  • To assess the incidence of incorrect needle placement and spread using ultrasound guidance.
  • To determine the safety and efficacy of the 'double-pop' landmark technique for TAP blocks.

Main Methods:

  • A prospective, blinded study was conducted on 36 adult patients undergoing general surgery.
  • Transversus abdominis plane (TAP) blocks were performed bilaterally using the standard landmark-based 'double-pop' technique.
  • Ultrasonography was employed to visualize and record the actual needle position and local anesthetic spread, with the performing anesthesiologist blinded to the ultrasound images.

Main Results:

  • The study was terminated early due to an unacceptably high rate of peritoneal needle placements.
  • Accurate needle tip and local anesthetic placement in the correct fascial plane occurred in only 23.6% of injections.
  • Incorrect placements included subcutaneous tissue (1.38%), external oblique muscle (1.38%), inter-oblique plane (6.94%), internal oblique muscle (36.1%), transversus abdominis muscle (12.5%), and peritoneum (18%).

Conclusions:

  • The standard landmark-based approach for transversus abdominis plane (TAP) blocks demonstrates significant inaccuracy in needle and local anesthetic placement.
  • The incidence of peritoneal needle placement during landmark-based TAP blocks is unacceptably high, raising safety concerns.
  • Ultrasound guidance is recommended for accurate and safe performance of TAP blocks.