S.Gupta, F.ElMedani, K Jain (2014) Laparoscopic guided Transversus Abdominus Plane (TAP) Block – a modiied technique. Int J Anesth Res. 2(7), 68-69. 68 www.scidoc.org/IJAR.php International Journal of Anesthesiology & Research (IJAR) ISSN 2332-2780 Laparoscopic Guided Transversus Abdominus Plane (Tap) Block – A Modiied Technique Brief Report S.Gupta 1* , F.ElMedani 2 , K Jain 3 1 Consultant Surgeon, Departments of Surgery and Radiology, Lister Hospital, Stevenage, Hertfordshire, SG1 4AB, UK. 2 Registrar Surgery, Departments of Surgery and Radiology, Lister Hospital, Stevenage, Hertfordshire, SG1 4AB, UK. 3 Consultant Radiologist, Departments of Surgery and Radiology, Lister Hospital, Stevenage, Hertfordshire, SG1 4AB, UK. *Corresponding Author: Sanjay Gupta, Consultant Surgeon, Departments of Surgery and Radiology, Lister Hos- pital, Stevenage, Hertfordshire, SG1 4AB, UK. E-mail: sanjay.gupta@nhs.net Recieved: August 18, 2014 Accepted: October 26, 2014 Published: October 27, 2014 Citation: S.Gupta, F.ElMedani, K Jain (2014) Laparoscopic guided Transversus Abdominus Plane (TAP) Block – a modiied tech- nique. Int J Anesth Res. 2(7), 68-69. Copyright: S.Gupta © 2014. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. Background Whilst performing ultra-sound guided TAP block, we have ob- served the distance between the peritoneum and the neuro-vas- cular plane (plane between transverses abdominus and internal oblique) in the mid-axillary line to be relatively constant between 3-4 mm (igure. 1). This was further conirmed on ultra-sound scanning of 10 healthy volunteers by our radiologist. This ana- tomical fact has been utilised as the basis of current Laparoscopic guided TAP block technique. Surgical technique Pneumo-insuffulation is induced by open Has on cannulation of the umbilicus. A21gauge graduated regional anaesthesia nee- dle (UniPlexNanoline, Pajunk® - igure. 2) is inserted through the skin in the mid axillary line midway between the costal arch and the iliac crest. The needle is advanced slowly until the needle tip reaches sub-peritoneal plane, easily identiied on laparoscopy by peritoneal tenting. Caution is exercised by inserting the nee- dle slowly so as to avoid any peritoneal puncture. Guided by the markings on the needle, the tip is then withdrawn by 3-4 mm so as to enter the neuro-vascular plane of the anterior abdominal wall. 20 ml of 0.25% Bupivacaine is then injected in this plane on each side (for bilateral blocks). The correct position of needle tip is conirmed by a slowly spreading bulge on laparoscopy (igure. 3). Abstract We present a modiied laparoscopic technique to administer quick and effective Tansversesus Abdominus Plane (TAP) block. The technique combines the beneit of laparoscopic guidance along with the knowledge of radiological anatomy of the abdominal wall. Keywords: TAP Block. Figure 1. Abdominal wall ultrasound showing distance be- tween the peritoneum (P) and the Transversus abdominus plane (TA). Figure 2. Pajunkuniplex regional anaesthesia needle (21 gauge) used for the technique.