Cutaneous sensory block area of the ultrasound-guided subcostal transversus abdominis plane block: an observational study

The transversus abdominis plane block (TAP) can be applied using different approaches, resulting in varying cutaneous analgesic distributions. This study aimed to assess the cutaneous sensory block area (CSBA) after ultrasound-guided TAP (US-TAP) using the subcostal approach.

Thirty patients undergoing elective laparoscopic cholecystectomy received a subcostal US-TAP with 20 mL 2.5 mg/mL ropivacaine bilaterally. Measurements were performed 150 min after block application. The CSBA was mapped using cold sensation and a sterile marker, photodocumented, and transferred to a transparency. The area of the CSBA was calculated from the transparencies.

The median CSBA of the subcostal US-TAP was 174 cm² (IQR 119-219 cm²; range 52-398 cm²). In all patients, the CSBA had a periumbilical distribution. In 42 of the 60 (70%) unilateral blocks, the CSBA had both an epigastric and infraumbilical component; in 12 of the 60 (20%) unilateral blocks, it covered only the epigastrium; and in 4 of the 60 (7%) unilateral blocks, it had only an infraumbilical distribution. No CSBA was found in 2 of the 60 (3%) unilateral blocks. In none of the patients did the CSBA cover the abdominal wall lateral to a vertical line through the anterior superior iliac spine.

The subcostal US-TAP results in a heterogeneous non-dermatomal CSBA with varying size and distribution across the medial abdominal wall.