Evolution of transversus abdominis plane infiltration techniques for postsurgical analgesia following abdominal surgeries

Abstract

Transversus abdominis plane (TAP) infiltration is a regional anesthesia technique that has been demonstrated to be effective for management of postsurgical pain after abdominal surgery. There are several different clinical variations in the approaches used for achieving analgesia via TAP infiltration, and methods for identification of the TAP have evolved considerably since the landmark-guided technique was first described in 2001. There are many factors that impact the analgesic outcomes following TAP infiltration, and the various nuances of this technique have led to debate regarding procedural classification of TAP infiltration. Based on our current understanding of fascial and neuronal anatomy of the anterior abdominal wall, as well as available evidence from studies assessing local anesthetic spread and cutaneous sensory block following TAP infiltration, it is clear that TAP infiltration techniques are appropriately classified as field blocks. While the objective of peripheral nerve block and TAP infiltration are similar in that both approaches block sensory response in order to achieve analgesia, the technical components of the two procedures are different. Unlike peripheral nerve block, which involves identification or stimulation of a specific nerve or nerve plexus, followed by administration of a local anesthetic in close proximity, TAP infiltration involves administration and spread of local anesthetic within an anatomical plane of the surgical site.

Keywords: TAP; liposome bupivacaine; pain.

Figure 1

Muscular anatomy of the posterolateral abdominal wall. Notes: The spinal nerves travel anteriorly between quadratus lumborum and latissimus dorsi before entering the plane between internal oblique and transversus abdominis muscles. Two possible infiltrative approaches are illustrated. Illustration courtesy of Pacira Pharmaceuticals, Inc.

Figure 2

Surface anatomical landmarks used in transversus abdominis plane block. Note: Reproduced with permission from Webster K. The transversus abdominis plane (TAP) block: abdominal plane regional anaesthesia. Update in Anaesthesia. 2008;24(1): 24–29. http://www.wfsahq.org/resources/update-in-anaesthesia. Abbreviations: EX OBL, external oblique; LAT DORSI, latissimus dorsi.

Figure 3

Ultrasound-guided lateral approach to transversus abdominis plane block. Notes: (A) is the external view and (B) is the internal ultrasound image (the arrow shows the transversus abdominis plane). Reproduced from Børglum J, Jensen K. Abdominal surgery: advances in the use of ultrasound-guided truncal blocks for perioperative pain management. In: Derbel F, editor. Abdominal Surgery. Rijeka, Croatia: InTech; 2012:69–94 (https://creativecommons.org/licenses/by-nc/4.0/). Abbreviations: EO, external oblique; IO, internal oblique; TA, transversus abdominis; PC, peritoneal cavity.