Top

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

23-08-2022 | Nerve Block | Reports of Original Investigations

Novel external oblique muscle plane block for blockade of the lateral abdominal wall: a pilot study on volunteers

Authors: Yuichi Ohgoshi, MD, Izumi Kawagoe, MD, PhD, Aki Ando, MD, Maria Ikegami, MD, Sayako Hanai, MD, Koichiro Ichimura, MD, PhD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 10/2022

Abstract

Purpose

No reports have described techniques to efficiently anesthetize the lateral cutaneous branches of the entire abdomen. The aim of this study was to investigate an effective procedure for blocking the lateral cutaneous branches in the abdominal region. We sought to describe the sensory distribution of the previously described thoracoabdominal nerve block through perichondrial approach (TAPA) and the novel costal and lateral external oblique muscle plane (EXOP) blocks in healthy volunteers.

Methods

This was a proof-of-concept pilot study that comprised ten volunteers with an American Society of Anesthesiologists Physical Status I. The participants underwent modified TAPA (M-TAPA), injection 2 of TAPA (injection into the anterior aspect of the 10th costal cartilage: I2-TAPA), costal EXOP, and lateral EXOP blocks with injection of 20 mL of ropivacaine 0.2% for each block. A pinprick test was performed one hour after injection and repeated at 30-min intervals until the effect of the nerve block disappeared.

Results

The M-TAPA injection anesthetized the anterior branches from T6/7 to T11/12, whereas the I2-TAPA injection had no effect. Costal and lateral EXOP injections anesthetized the lateral cutaneous branches of T7–10 and T11–12, respectively.

Conclusion

The results of this pilot study in ten healthy volunteers indicate that novel EXOP blocks involving local anesthetic injection superficial to the external oblique muscle efficiently anesthetize the lateral cutaneous branches of the thoracoabdominal nerves. Our study shows that it may be anatomically plausible for the combined use of these blocks to anesthetize the entire abdominal wall.

White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg 2005; 101: S5–22. https://doi.org/10.1213/01.ane.0000177099.28914.a7CrossRefPubMed

Hebbard P. Subcostal transversus abdominis plane block under ultrasound guidance. Anesth Analg 2008; 106: 674–5. https://doi.org/10.1213/ane.0b013e318161a88fCrossRefPubMed

Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care 2007; 35: 616–7.PubMed

El-Dawlatly AA, Turkistani A, Kettner SC, et al. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth 2009; 102: 763–7. https://doi.org/10.1093/bja/aep067CrossRefPubMed

Carney J, Finnerty O, Rauf J, Bergin D, Laffey JG, McDonnell JG. Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks. Anaesthesia 2011; 66: 1023–30. https://doi.org/10.1111/j.1365-2044.2011.06855.xCrossRefPubMed

Shibata Y, Sato Y, Fujiwara Y, Komatsu T. Transversus abdominis plane block. Anesth Analg 2007; 105: 883. https://doi.org/10.1213/01.ane.0000268541.83265.7dCrossRefPubMed

Yoshiyama S, Ueshima H, Sakai R, Otake H. A posterior TAP block provides more effective analgesia than a lateral TAP block in patients undergoing laparoscopic gynecologic surgery: a retrospective study. Anesthesiol Res Pract 2016; 2016: 4598583. https://doi.org/10.1155/2016/4598583CrossRefPubMedPubMedCentral

Faiz SH, Alebouyeh MR, Derakhshan P, Imani F, Rahimzadeh P, Ashtiani MG. Comparison of ultrasound-guided posterior transversus abdominis plane block and lateral transversus abdominis plane block for postoperative pain management in patients undergoing cesarean section: a randomized double-blind clinical trial study. J Pain Res 2017; 11: 5–9. https://doi.org/10.2147/jpr.s146970CrossRefPubMedPubMedCentral

Furuya T, Kato J, Yamamoto Y, Hirose N, Suzuki T. Comparison of dermatomal sensory block following ultrasound-guided transversus abdominis plane block by the lateral and posterior approaches: a randomized controlled trial. J Anaesthesiol Clin Pharmacol 2018; 34: 205–10. https://doi.org/10.4103/joacp.joacp_295_15CrossRefPubMedPubMedCentral

10.

Tran TM, Ivanusic JJ, Hebbard P, Barrington MJ. Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study. Br J Anaesth 2009; 102: 123–7. https://doi.org/10.1093/bja/aen344CrossRefPubMed

11.

Hebbard PD, Barrington MJ, Vasey C. Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade description of anatomy and clinical technique. Reg Anesth Pain Med 2010; 35: 436–41. https://doi.org/10.1097/aap.0b013e3181e66702CrossRefPubMed

12.

Chen Y, Shi K, Xia Y, et al. Sensory assessment and regression rate of bilateral oblique subcostal transversus abdominis plane block in volunteers. Reg Anesth Pain Med 2018; 43: 174–9. https://doi.org/10.1097/aap.0000000000000715CrossRefPubMed

13.

Tulgar S, Senturk O, Selvi O, et al. Perichondral approach for blockage of thoracoabdominal nerves: anatomical basis and clinical experience in three cases. J Clin Anesth 2019; 54: 8–10. https://doi.org/10.1016/j.jclinane.2018.10.015CrossRefPubMed

14.

Tulgar S, Selvi O, Thomas DT, Deveci U, Özer Z. Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides effective analgesia in abdominal surgery and is a choice for opioid sparing anesthesia. J Clin Anesth 2019; 55: 109. https://doi.org/10.1016/j.jclinane.2019.01.003CrossRefPubMed

15.

Balaban O, Tulgar S, Ahiskalioğlu A, Thomas DT, Aydin T. Blockage of thoracoabdominal nerves through perichondrial approach (TAPA) for surgical anesthesia after failed erector spinae plane block in mini-laparatomy. J Clin Anesth 2019; 55: 74–5. https://doi.org/10.1016/j.jclinane.2018.12.054CrossRefPubMed

16.

Altıparmak B, Korkmaz Toker M, Uysal Aİ, Turan M, Gümüş Demirbilek S. The successful usage of modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) for analgesia of laparoscopic ventral hernia repair. J. Clin Anesth 2019; 57: 1–2. https://doi.org/10.1016/j.jclinane.2019.02.016CrossRefPubMed

17.

Aikawa K, Tanaka N, Morimoto Y. Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides a sufficient postoperative analgesia for laparoscopic sleeve gastrectomy. J Clin Anesth 2020; 59: 44–5. https://doi.org/10.1016/j.jclinane.2019.06.020CrossRefPubMed

18.

Tanaka N, Yagi Y, Aikawa K, Morimoto Y. Anesthetic management by blockage of thoracoabdominal nerves through perichondrial approach (TAPA) for open nephrectomy in a pediatric patient with Wilms tumor. J Clin Anesth 2020; 59: 51–2. https://doi.org/10.1016/j.jclinane.2019.06.019CrossRefPubMed

19.

Ohgoshi Y, Ando A, Kawamata N, Kubo EN. Continuous modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) for major abdominal surgery. J Clin Anesth 2020; 60: 45–6. https://doi.org/10.1016/j.jclinane.2019.08.031CrossRefPubMed

20.

Gomes de Oliveira EJ, De Lima RC, Sakata RK, et al. Modified thoracoabdominal nerve block through the perichondral approach (M-TAPA) in laparoscopic sleeve gastroplasty: a case series. Obes Surg 2022; 32: 197–201. https://doi.org/10.1007/s11695-021-05612-6

21.

Hamilton DL, Manickam BP, Wilson MA, Abdel Meguid E. External oblique fascial plane block. Reg Anesth Pain Med 2019; 44: 528–9. https://doi.org/10.1136/rapm-2018-100256CrossRef

22.

Elsharkawy H, Kolli S, Soliman LM, et al. The external oblique intercostal block: anatomic evaluation and case series. Pain Med 2021; 22: 2436–42. https://doi.org/10.1093/pm/pnab296CrossRefPubMed

23.

Fernández Martín MT, López Álvarez S, Pérez Herrero MA. Serratus-intercostal interfascial block as an opioid-saving strategy in supra-umbilical open surgery. Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65: 456–60. https://doi.org/10.1016/j.redar.2018.03.007CrossRef

24.

Vasco-Blázquez Á, Avello-Taboada R, Sanllorente-Sebastián R, González-Barrera V, Arroyo-García B, Balzategi-Urritia A. Serratus-intercostal plane block for breast surgery in pregnant women. Minerva Anestesiol 2019; 85: 1370–2. https://doi.org/10.23736/s0375-9393.19.13823-0

25.

Kaur U, Shamshery C, Agarwal A, Prakash N, Valiveru RC, Mishra P. Evaluation of postoperative pain in patients undergoing modified radical mastectomy with pectoralis or serratus-intercostal fascial plane blocks. Korean J Anesthesiol 2020; 73: 425–33. https://doi.org/10.4097/kja.20159CrossRefPubMedPubMedCentral

26.

Selvi O, Tulgar S, Senturk O, et al. Is a combination of the serratus intercostal plane block and rectus sheath block superior to the bilateral oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy? Eurasian J Med 2020; 52: 34–7. https://doi.org/10.5152/eurasianjmed.2019.19048CrossRefPubMedPubMedCentral

27.

Aikawa K, Yokota I, Maeda Y, Morimoto Y. Evaluation of sensory loss obtained by modified thoracoabdominal nerves block through perichondrial approach in patients undergoing gynecological laparoscopic surgery: a prospective observational study. Reg Anesth Pain Med 2022; 47: 134–5. https://doi.org/10.1136/rapm-2021-102870CrossRefPubMed

28.

Tsai HC, Yoshida T, Chuang TY, et al. Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int 2017; 2017: 8284363. https://doi.org/10.1155/2017/8284363CrossRefPubMedPubMedCentral

29.

Tran DQ, Bravo D, Leurcharusmee P, Neal JM. Transversus abdominis plane block: a narrative review. Anesthesiology 2019; 131: 1166–90. https://doi.org/10.1097/aln.0000000000002842CrossRefPubMed

Title: Novel external oblique muscle plane block for blockade of the lateral abdominal wall: a pilot study on volunteers
Authors: Yuichi Ohgoshi, MD
Izumi Kawagoe, MD, PhD
Aki Ando, MD
Maria Ikegami, MD
Sayako Hanai, MD
Koichiro Ichimura, MD, PhD
Publication date: 23-08-2022
Publisher: Springer International Publishing
Keyword: Nerve Block
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 10/2022
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-022-02310-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Novel external oblique muscle plane block for blockade of the lateral abdominal wall: a pilot study on volunteers

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2022

White blood cell count trajectory and mortality in septic shock: a historical cohort study

A case report of recreational use of inhaled Freon leading to acute hypoxemic respiratory failure salvaged by veno-venous extracorporeal membrane oxygenation

Developing the BreakThrough Pain Risk Score: an interpretable machine-learning-based risk score to predict breakthrough pain with labour epidural analgesia

A retrospective review of pregnant patients critically ill with COVID-19 in a tertiary referral centre

Evaluation of an advanced critical care echocardiography program: a mixed methods study

In reply: Hemidiaphragmatic paresis associated with interscalene nerve block