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TAP BLOCK что нового ///////////ooooooo
- 1. TAP blockade –what’s new? by Ass. prof. Jens Børglum, MD, PhD Anaesthesiology, Zealand University Roskilde, Denmark
- 2. Conflict of interests: Supportedby SECMA in Scandinavia
- 3. TAP blockade –what’s new? • Basically there is nothing new – a brief view of the history • What began as a so-called posterior TAP block initially evolved into new blocks – more anterior blocks • We are now again searching for various approaches that are more posterior • We now look more for visceral pain amelioration • Epidural block is on the decline in the Western world • Obstetric surgery is the exception • The holy grail is the thoracic paravertebral block – without actually being this!!! • We search for new approaches!
- 5. What about AbdominalWall Blocks?
- 6. What about AbdominalWall Blocks?
- 7. 4 kind ofTAP block techniques currently in general use 1. Prof. O´Donnell & Prof. McDonnell (landmark based, triangle of Petit) • First movers, extensive dermatomal anaesthesia, long lasting effect • Primarily blind double pop technique, but also USG technique 2. Prof. Hebbard (oblique subcostal TAP block) • Aim: to anaesthetize all dermatomes Th6-Th12 • Insertion of catheters for continous pain management • Requires some time and extensive anatomical knowledge 3. Classical USG TAP block (anterior/middle axillary line) • Below the thoracic cage, above the iliac crest • Two injections, fast and easy • Primarily the lower abdomen Th10-Th12 • Perhaps the USG technique most frequently in clinical use today 4. Bilateral Dual TAP (BD-TAP) block (Børglum J & Jensen K) • 4 point ultrasound-guided strategy • Single-shot, fast and easy • Anaesthetizing all dermatomes from Th6-Th12 bilaterally
- 8. • Reg AnesthPain Med. 2006 Jan-Feb;31(1):91. The transversus abdominis plane (TAP) block in open retropubic prostatectomy. O'Donnell BD, McDonnell JG, McShane AJ. • Reg Anesth Pain Med. 2007 Sep-Oct;32(5):399-404. Transversus abdominis plane block: a cadaveric and radiological evaluationMcDonnell JG, O'Donnell BD, Farrell T, Gough N, Tuite D, Power C, Laffey JG. • Anesth Analg. 2007 Jan;104(1):193-7. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. McDonnell JG, O'Donnell B, Curley G, Heffernan A, Power C, Laffey JG. • Anesth Analg. 2008 Jan;106(1):186-91, table of contents. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. McDonnell JG, Curley G, Carney J, Benton A, Costello J, Maharaj CH, Laffey JG. Prof. O’Donnell BD & Prof. McDonnell JG – Triangle of Petit • Two injections • Both blind, landmarked-based & USG blocks in the Triangle of Petit • Extensive scientific evidence for positive effects • Double pop technique • Extensive dermatomal anaesthesia • Long lasting effect
- 9. Prof. Hebbard PD– The Oblique Subcostal TAP block • Reg Anesth Pain Med. 2010 Sep-Oct;35(5):436-41. Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade: description of anatomy and clinical technique. Hebbard PD, Barrington MJ, Vasey C. • Disection technique • Ultrasound-guided technique • Aims to anaesthetize the entire abdominal wall (Th6-Th12(L1)) • Continuous anaesthesia • A catheter can be placed along the oblique subcostal line in the transversus abdominis plane for continuous infusion of local anesthetic. Multimodal analgesia and intravenous opioid are used in addition because visceral pain is not blocked. Continuous oblique subcostal transversus abdominis plane block is a new technique and requires both a detailed knowledge of sonographic anatomy and technical skill for it to be successful.
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- 12. The Classical TAPblock • Br J Anaesth. 2009 Jun;102(6):763-7. Epub 2009 Apr 17. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. El-Dawlatly AA, Turkistani A, Kettner SC, Machata AM, Delvi MB, Thallaj A, Kapral S, Marhofer P. • Anesth Analg. 2007 Sep;105(3):883; author reply 883. Transversus abdominis plane block. Shibata Y, Sato Y, Fujiwara Y, Komatsu T. • Ultrasound-guided technique • Above the pelvic crest and below the costal margin • Anterior/medial axillary line • Aim to anaesthetize as much of the abdominal wall as possible • Simple to understand, simple to execute • Probably the technique preferred by most physicians • Anatomical structures are clearly visible • Two injections
- 13. Bilateral Dual -Transversus abdominis plane (TAP) block Katrina Webster; Royal Hobart Hospital, Australia: The Transversus Abdominis Plane (TAP) block: Abdominal Plane Regional Anaesthesia
- 15. The Bilateral DualTAP (BD-TAP) block • Large branch communications anterolaterally (intercostal plexus) – Th6-Th9 • Large branch communications in plexuses that run with the deep circumflex iliac artery (DCIA) (TAP plexus) – lower lateral abdomen – Th10-Th12 (L1) • Large brance communications that run with the deep inferior epigastric artery (DIEA) (rectus sheath plexus). Th6-Th12 (L1)
- 16. The Bilateral DualTAP (BD-TAP) block (Børglum J et al. Reg Anesth Pain Med. 2012 May-Jun;37(3):294-301)
- 17. Upper Intercostal TAPblock (Th6-Th9)
- 18. Lateral Classical TAPblock (Th10-Th12)
- 19. (Børglum J etal. Reg Anesth Pain Med. 2012 May-Jun;37(3):294-301) The Bilateral Dual TAP (BD-TAP) block
- 23. TEQUILA BLOCK: The TransmuscularQuadratus Lumborum (TQL) block – Where, When, Why and How?
- 25. Source: LSORA >The Blanco block: a Quadratus lumborum block The Blanco block – the first QL block
- 26. Carney et al– the ”posterior approach”
- 30. The Quadratus Lumborummuscle
- 31. The Quadratus Lumborummuscle
- 32. The Quadratus Lumborummuscle
- 33. Transmuscular Quadratus Lumborum Block= TQL Block = Tequila Block
- 34. Transmuscular Quadratus Lumborum(TQL) Block
- 35. Transmuscular Quadratus Lumborum(TQL) Block
- 40. Transmuscular Quadratus Lumborum(TQL) Block
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- 43. Posterior Anterior Transverse Oblique Paramedian= TOP TQL block
- 44. Anterior Posterior Transverse Oblique Paramedian= TOP TQL block
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- 53. • WHEN: Indicatedfor abdominal and retroperitoneal surgery • WHERE: Administered between QL and PMM • WHY: Spreads to the Thoracic Paravertebral Space • WHY: Alleviates visceral pain • WHY: Long lasting effect > 24 hours • HOW: It’s obvious – the TEQUILA way!
- 54. Thank you forlistening…… any questions?