By the end of this lecture, the learner will be able to:
1. Review the anatomy and techniques for new interfascial plane blocks;
2. Discuss the evidence for these regional analgesic procedures; and
3. Present an approach to evaluate new techniques.
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Interfascial Plane Blocks: Should We Believe the Hype?
1. @EMARIANOMD
#WAS2020
Interfascial Plane Blocks
Should We Believe the Hype?
Edward R. Mariano, M.D., M.A.S.
Professor of Anesthesiology, Perioperative & Pain Medicine
Stanford University School of Medicine
Chief, Anesthesiology and Perioperative Care
Veterans Affairs Palo Alto Health Care System
5. @EMARIANOMD #WAS2020
Transversus Abdominis Plane (TAP) Block
Patient supine
Identify Triangle of
Petit in mid-axillary line
cephalad to iliac crest
Needle is inserted
perpendicular to skin
through T of P
After 2 “pops,” inject
local anesthetic
McDonnell JG. A&A 2007;105:883
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TAP Block vs. Placebo
3 randomized, placebo-controlled trials:
bilateral TAP injections with ropivacaine vs.
saline for hysterectomy1 and C-section2,3
– Lower VAS pain scores in TAP group1,2
– Lower total morphine consumption (mg) in
TAP group1-3
– Less antiemetic therapy and higher satisfaction
with pain relief in TAP group3
1. Carney J. A&A 2008;107:2056
2. McDonnell JG. A&A 2008;106:186
3. Belavy. BJA 2009;103:726
19. @EMARIANOMD #WAS2020
Role for Rescue Analgesia?
3 cases of bilateral TAP blocks used for
rescue analgesia s/p CS under spinal
Mean decrease in pain score=7; mean
duration=14 hrs
Mirza & Carvalho. CJA 2013;60:299