ISPUB.COM The Internet Journal of Anesthesiology Volume 15 Number 2 1 of 3 Unilateral US guided TAP block for abdominal surgery A El-Dawlatly, A Thallaj, A Aldohayan, A Alzoman Citation A El-Dawlatly, A Thallaj, A Aldohayan, A Alzoman. Unilateral US guided TAP block for abdominal surgery. The Internet Journal of Anesthesiology. 2007 Volume 15 Number 2. Abstract The use of Ultrasound (US) guided nerve blocks is evolving. Currently the trend in regional blocks is moving slowly from using electric nerve stimulation to the use of US techniques. In patients undergoing anesthesia for abdominal surgery, perioperative pain relief is a major issue. Perioperative pain relief interventions believed to reduce co-morbidities among surgical patients. Conventional pain relief techniques involve the use of opioid analgesic drugs with their untoward effects. We report a case of laparoscopic surgery where we used US guided transversus abdominis plane (TAP) block for intra and postoperative pain relief. CASE REPORT A-48-yr old male patient was scheduled to undergo laparoscopic right inguinal and epigastric hernia repair under general anesthesia. His body weight was 84kg and he was otherwise healthy with no previous medical diseases. Preoperative visit revealed an ASA I patient with normal laboratory tests. After connecting the patient to routine monitoring induction of anesthesia was achieved with sufentanil 10mic and propofol 200mg. Endotracheal intubation was facilitated with atracurium 40mg. Maintenance of anesthesia was achieved with O2/air and 1MAC sevoflurane. Unilateral right sided TAP block was performed using US guided technique (high frequency ,5-13MHz linear transducer, LOGIQ e, GE). Using the transducer visualization of the abdominal wall compartments was achieved on the right side at mid clavicular line. The different layers visualized were, from below upward: the moving bowel, peritoneum, transversus abdominis muscle, internal oblique and external oblique muscles (Figure 1). Using a long 2 inches insulated needle (Braun Melsungen, Germany) puncture the abdominal wall linear to the transducer was performed. Under US scanning the shaft of the needle was visualized piercing the external then internal oblique muscles. Between the internal oblique and the transversus abdominis muscles the needle was placed and bupivacaine 25ml (0.25%) was injected followed by separation of the plane between the two muscles. Surgery then commenced with one port subumbilical and one port on the right side plus two other ports in the left side of the abdominal wall. Hemodynamic changes were recorded throughout the procedure which included peritoneal insufflation of CO2 at 15mmHg. The operation lasted for 70 min and it was uneventful. The hemodynamic data at different stages of surgery are given in table 1. Throughout the procedure the patient received only 10mic sufentanil at induction of anesthesia. In the recovery room he received 2mg morphine i.v then PCA with morphine started and continued for 24hr where the total dose given over that period was 21mg, then PCA was discontinued. Figure 1 Figure 1: US scanning showed different abdominal wall layers. Figure 2 Table 1: Hemodynamic changes during different surgical phases