Published in:
Open Access
01-12-2019 | Laparotomy | Regional Anesthesia (P Kukreja, Section Editor)
Transversus Abdominis Plane (TAP) and Rectus Sheath Blocks: a
Technical Description and Evidence Review
Authors:
Vishal Uppal, Sushil Sancheti, Hari Kalagara
Published in:
Current Anesthesiology Reports
|
Issue 4/2019
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Abstract
Purpose of Review
This article aims to review the anatomy relevant to the ultrasound
techniques of the transversus abdominis plane (TAP) block and rectus sheath
block (RSB). We discuss their analgesic efficacy for various surgical
procedures, both as single shot and as a continuous infusion via
catheters.
Recent Findings
RSB provides superior analgesia to local infiltration and has an
opioid-sparing effect for umbilical surgery, laparotomy, and laparoscopic
surgery. There is no high-quality evidence comparing RSB with epidural
analgesia. Intermittent bolus through catheters appears to be more effective
than continuous infusion for prolonged analgesia. Similarly, ultrasound-guided
TAP block provides postoperative analgesic benefit after abdominal laparotomy or
laparoscopy and cesarean delivery when long-acting neuraxial opioids are not
used or contraindicated. Adding adjuvant such as dexamethasone and
dexmedetomidine to local anesthetic prolongs the duration of TAP and RSB blocks
and improves their efficacy.
Summary
Use of ultrasound guidance makes the RSB and TAP blocks more
reliable. Single-shot infiltration is useful for less extensive surgical
procedures, while catheters are a useful alternative when thoracic epidural
analgesia is contraindicated.