Tips and Tricks of Performing Surgically Inserted TAP Catheters for Hepatectomy

Excerpt

We read with interest the recent report by Dr. Thornblade et al. implementing the surgically inserted transversus abdominis plane (TAP) block in an enhanced recovery after surgery (ERAS) protocol for open hepatectomy.¹ We commend the authors for demonstrating both analgesia and cost-benefit advantages, by infusing local anesthetics or liposomal bupivacaine via TAP catheters. Although traditionally TAP catheter insertion is performed under ultrasound guidance (USG), there is strong interest in surgeon-initiated TAP blocks (SITB) due to the proposed advantages of improved accuracy in placing the nerve block catheter and reduction in complications, time, expertise, and need for anesthetic equipment.² One of the reasons for the resistance in adoption of the SITB is the lack of analgesic efficacy noted in some studies.^2,3 Possibly, technical aspects of catheter insertion might affect the analgesic efficacy. Hence, given the results of the study by Thornblade et al., readers may benefit from a detailed description of the technique and we describe the technique employed at our institution since 2008 for hepatobiliary surgeries requiring subcostal incisions. …