SlideShare ist ein Scribd-Unternehmen logo
1 von 31
Downloaden Sie, um offline zu lesen
Welcome to the US-guided nerve blocks training programme
Ultrasound-Guided
Transversus Abdominis Plane Blocks
Institute of Pain Medicine & Research Centre
Dept of Anaesthesia & Pain Medicine
Evercare Hospital Dhaka
Lt Col (Retd) Dr Md Rabiul Alam
Senior Consultant
Dept of Anaesthesia & Pain Medicine
Evercare Hospital Dhaka
Objectives
• Identifying the patients who would benefit from Transversus
Abdominis Plane (TAP) blocks
• Relevant anatomy associated with TAP blocks
• Several techniques to approach TAP blocks
• Importance of an interprofessional team
Importance
• A rise in opioid-related adverse effects and death has led to a surge in
utilizing alternative methods to treat pain
Opioid-related deaths
Ref: Kaplovitch E, Gomes T, Camacho X, Dhalla IA, Mamdani MM, Juurlink DN (2015) Sex Differences in
Dose Escalation and Overdose Death during Chronic Opioid Therapy: A Population-Based Cohort Study.
PLoS ONE 10(8): e0134550. doi:10.1371/ journal.pone.0134550
Opioid-related deaths…
Ref: Gomes T, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. The Burden of Opioid-Related Mortality
in the United States. JAMA Netw Open. 2018 Jun 1;1(2):e180217. doi:
10.1001/jamanetworkopen.2018.0217.
Introduction…
• US-guided RA parallels the rapid rise in availability of US machines
• Abdominal wall is a common source of pain after abdominal surgeries
• US-guided TAP blocks provide reliable relief of somatic incisional pain
• A great adjunct to a multimodal analgesic regimen
• Spares visceral pain relief(!), necessitate additional analgesic modes
• Creates a non-dermatomal field block
History
Ahmed Nadeem Rafi, MD
Institute of
Interventional Pain
Management
Russellville, Arkansas,
United States
Ref: Rafi A. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia
2001; 56: 1024- 26
History…
Ref: Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis
plane (TAP) block. Anaesth Intensive Care. 2007 Aug;35(4):616-7
Indications
• Major abdominal surgeries
• Colorectal surgeries - alternative to epidural anaesthesia(!)
• Hernia repairs
• Procedures involving the abdominal wall
• Cesarean section
• Appendectomy, abdominal hysterectomy, abdominoplasty, prostatectomy
• Laparoscopic surgeries
Contraindications
• Patient refusal
• Active infection over the site of injection
• Practice caution in patients
• Taking anticoagulation
• Pregnant patient
• Patients where anatomical landmarks are indistinguishable
• Avoid local anesthetics in those with known allergies
Anatomy
• The anterolateral abdominal wall is bound
• Laterally by the posterior axillary lines
• Superiorly:
• costal margin of the 7th to 10th ribs
• xiphoid process
• Inferiorly:
• Iliac crest
• Inguinal ligament
• Pubic crest
• Symphysis
Anatomy… muscles
• The muscles of the anterolateral
abdominal wall, from superficial to deep
• External oblique
• Internal oblique
• Transversus abdominis
• TAP is the fascial plane that separates the
TA from the IO muscle
Anatomy… nerves
• Innervation of the anterolateral
abdominal wall is composed of
• Thoracoabdominal nerves
• Ilioinguinal
• Iliohypogastric nerves which
communicate to form the upper and
lower TAP plexuses
Anatomy… nerves
• T6 entering just lateral to the linea alba
• T7-T9 enter the TAP medial to the
anterior axillary line
• T10-T12 nerves enter more laterally and
can be blocked in the midaxillary line
between the bottom of the thoracic
cage and the top of the iliac crest
Requirements
• US machine with a high frequency probe (10-5 MHz), linear, curvelinear
• US probe cover
• Antiseptic for skin disinfection
• Sterile ultrasound gel
• Needle: 50/80/100 mm needles
• 10/20ml syringes and injection tubing
• 40 to 60 ml local anaesthetic (this block relies on local anaesthetic spread rather than
concentration, i.e. is volume dependent)
Personnel
• Trained and skilled medical providers, including anesthesiologists, can
perform TAP blocks
• Typically a second healthcare provider or nurse is required for time-
out before starting the procedure, and to assist with the injection of
local anesthetic
Preparations
• Discuss risks, benefits, alternatives with the patient & obtain informed consent
• Monitoring: ECG, SpO2, and BP every 5 minutes
• IV access
• Position the patient supine and uncover the abdomen
• Be sure to thoroughly clean the skin over the anterolateral abdomen, from the
costal margin to iliac crest, followed by placement of sterile towels
surrounding the border of the procedural field
• A procedural time-out should take place prior to starting the procedure
Types of TAP blocks
• Subcostal
• Lateral
• Posterior
• Anterior (iliohypogastric & ilioinguinal nerves block)
Plus
• Rectus Sheath nerve blocks
Subcostal
Lateral
Posterior
Anterior (IH & II nerves)
Distribution of block: hypogastric region, inguinal crease, upper medial thigh,
mons pubis, part of labia, root of the penis, & anterior part of the scrotum
Rectus sheath nerve block
Distribution of block: periumbilical area (spinal dermatomes 9, 10, & 11)
Complications
• Field blocks are safer, neurological injury is rare
• Nerve trauma, hematoma
• Intraperitoneal injection, visceral trauma, vascular injury, and liver trauma
• Transient femoral nerve palsy
• Essential to well visualizing the LA injection within TAP
• Be cautious to avoid vascular puncture and intravascular injection
• LA systemic toxicity is a rare but known complication
Team approach…
• A team-based, interprofessional methodology
• Communication with the surgeon
• Location of the incision, timing of the block, and other unique considerations
• Time-out to promote patient safety
• Verbal contact with the patient throughout the procedure
• Extreme caution when handling sharps as accidental needle sticks may occur
• Sharps require disposal using appropriately marked bins
• Documentations
Organizational initiatives
• An interprofessional team: clinicians (both general & specialists), nurses, surgical
assistants, and pharmacists
• Clinicians should send the patient to the specialists, who will prepare the patient for the
procedure in conjunction with the nursing staffs
• The pharmacy will prepare the anesthetic and can act as a resource for any medication-
related questions by the team
• Nursing will assist during the procedure, and additional nursing duties
• Interprofessional team will optimize the results from a TAP block leading to better
patient outcomes
Nursing assistance
• Nurse is in charge of setting up the instrument tray for the block
• Nurse may position and prep the patient for the procedure
• Nurse is also responsible for making sure that the patient has signed
consent
• And that the procedure is taking place on the correct side of the
abdominal pathology
Nursing assistance…
• Before starting the procedure, the nurse must make sure that
resuscitative equipment is in the room
• One nurse should be dedicated to the monitoring of the patient
during and after the procedure
• In the recovery room, the nurse should assess the patient's
hemodynamic status and evaluated the site of the block for bleeding
Take-home messages
• Selection of appropriate candidates
• Preparations of patients, OR/procedural room & ancilliaries
• Skills & perfections for good outcomes
• Development of an organized team & patients’ safety net
• Obtaining adequate peers’ & administrative supports
• Rational projections & marketing for viability
Conclusion
• TAP blocks have become an important addition to multimodal pain
management for abdominal wall surgery
• The safety, ease, and effectiveness of the block make it an excellent
adjunct to perioperative pain management
References
1. Kaplovitch E, Gomes T, Camacho X, Dhalla IA, Mamdani MM, Juurlink DN (2015) Sex Differences in Dose Escalation and Overdose Death
during Chronic Opioid Therapy: A Population-Based Cohort Study. PLoS ONE 10(8): e0134550
2. Gomes T, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. The Burden of Opioid-Related Mortality in the United States. JAMA Netw
Open. 2018 Jun 1;1(2):e180217
3. Rafi A. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 2001; 56: 1024- 26
4. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007
Aug;35(4):616-7
5. Hammi C, Ahn K. Transversus Abdominis Plane Block. [Updated 2022 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547730/
6. Mukhtar K. Transversus Abdominis Plane (TAP) block. The Journal of NYSORA 2009; 12: 28-33
7. Elsharkawy H, Bendtsen TF. Ultrasound-Guided Transversus Abdominis Plane and Quadratus Lumborum Nerve Blocks.
https://www.nysora.com/topics/regional-anesthesia-for-specific-surgical-procedures/abdomen/ultrasound-guided-transversus-
abdominis-plane-quadratus-lumborum-blocks/ (Accessed on 12 June 2022)

Weitere ähnliche Inhalte

Was ist angesagt?

Truncal blocks.pptx
Truncal blocks.pptxTruncal blocks.pptx
Truncal blocks.pptxDawitGetnet1
 
Pec I and PECS II, serratus anterior block
Pec I and PECS II, serratus anterior blockPec I and PECS II, serratus anterior block
Pec I and PECS II, serratus anterior blockArun Shetty
 
Regional anaesthesia lower limb blocks
Regional anaesthesia lower limb blocksRegional anaesthesia lower limb blocks
Regional anaesthesia lower limb blocksCherush Thomas
 
Concepts in Fascial Plane Blocks - What Every Anaesthetist Needs to Know
Concepts in Fascial Plane Blocks - What Every Anaesthetist Needs to KnowConcepts in Fascial Plane Blocks - What Every Anaesthetist Needs to Know
Concepts in Fascial Plane Blocks - What Every Anaesthetist Needs to KnowAmit Pawa
 
Scalp block and New GCS (GCS-P)
Scalp block and New GCS (GCS-P)Scalp block and New GCS (GCS-P)
Scalp block and New GCS (GCS-P)Tenzin yoezer
 
Statistics for Anaesthesiologists
Statistics for AnaesthesiologistsStatistics for Anaesthesiologists
Statistics for Anaesthesiologistsxeonfusion
 
Regional anaesthesia strategies for upper limb surgeries
Regional anaesthesia strategies for upper limb surgeriesRegional anaesthesia strategies for upper limb surgeries
Regional anaesthesia strategies for upper limb surgeriesGopan Gopalakrisna Pillai
 
Erector spinae plane block for pain management
Erector spinae plane block for pain managementErector spinae plane block for pain management
Erector spinae plane block for pain managementmohamed abuelnaga
 
Failed spinal-anesthesia-mgmc
Failed spinal-anesthesia-mgmcFailed spinal-anesthesia-mgmc
Failed spinal-anesthesia-mgmcHarith Daggupati
 
Ischemic heart disease and anesthetic management
Ischemic heart disease and anesthetic managementIschemic heart disease and anesthetic management
Ischemic heart disease and anesthetic managementkrishna dhakal
 
Regional Blocks of the Upper Limb and Thorax RRT
Regional Blocks of the Upper Limb and Thorax RRTRegional Blocks of the Upper Limb and Thorax RRT
Regional Blocks of the Upper Limb and Thorax RRTRanjith Thampi
 
Upper limb blocks
Upper limb blocksUpper limb blocks
Upper limb blocksAhmed Tarek
 
Low flow Anesthesia system
Low flow  Anesthesia systemLow flow  Anesthesia system
Low flow Anesthesia systemKIMS
 
Ultrasound guided truncal blocks
Ultrasound guided truncal blocksUltrasound guided truncal blocks
Ultrasound guided truncal blocksrazishahid
 

Was ist angesagt? (20)

Truncal blocks.pptx
Truncal blocks.pptxTruncal blocks.pptx
Truncal blocks.pptx
 
Pec I and PECS II, serratus anterior block
Pec I and PECS II, serratus anterior blockPec I and PECS II, serratus anterior block
Pec I and PECS II, serratus anterior block
 
Regional anaesthesia lower limb blocks
Regional anaesthesia lower limb blocksRegional anaesthesia lower limb blocks
Regional anaesthesia lower limb blocks
 
Brachial plexus block
Brachial plexus blockBrachial plexus block
Brachial plexus block
 
Concepts in Fascial Plane Blocks - What Every Anaesthetist Needs to Know
Concepts in Fascial Plane Blocks - What Every Anaesthetist Needs to KnowConcepts in Fascial Plane Blocks - What Every Anaesthetist Needs to Know
Concepts in Fascial Plane Blocks - What Every Anaesthetist Needs to Know
 
Scalp block and New GCS (GCS-P)
Scalp block and New GCS (GCS-P)Scalp block and New GCS (GCS-P)
Scalp block and New GCS (GCS-P)
 
Statistics for Anaesthesiologists
Statistics for AnaesthesiologistsStatistics for Anaesthesiologists
Statistics for Anaesthesiologists
 
Regional anaesthesia strategies for upper limb surgeries
Regional anaesthesia strategies for upper limb surgeriesRegional anaesthesia strategies for upper limb surgeries
Regional anaesthesia strategies for upper limb surgeries
 
Erector spinae plane block for pain management
Erector spinae plane block for pain managementErector spinae plane block for pain management
Erector spinae plane block for pain management
 
Failed spinal-anesthesia-mgmc
Failed spinal-anesthesia-mgmcFailed spinal-anesthesia-mgmc
Failed spinal-anesthesia-mgmc
 
ESP block
ESP blockESP block
ESP block
 
Anaesthesia for laparoscopic surgeries
Anaesthesia for laparoscopic surgeriesAnaesthesia for laparoscopic surgeries
Anaesthesia for laparoscopic surgeries
 
Ischemic heart disease and anesthetic management
Ischemic heart disease and anesthetic managementIschemic heart disease and anesthetic management
Ischemic heart disease and anesthetic management
 
Exparel
ExparelExparel
Exparel
 
Quadratus Lumborum Block - Dr. V Koyyalamudi
Quadratus Lumborum Block - Dr. V KoyyalamudiQuadratus Lumborum Block - Dr. V Koyyalamudi
Quadratus Lumborum Block - Dr. V Koyyalamudi
 
Regional Blocks of the Upper Limb and Thorax RRT
Regional Blocks of the Upper Limb and Thorax RRTRegional Blocks of the Upper Limb and Thorax RRT
Regional Blocks of the Upper Limb and Thorax RRT
 
NON OPERATING ROOM ANAESTHESIA
NON OPERATING ROOM ANAESTHESIANON OPERATING ROOM ANAESTHESIA
NON OPERATING ROOM ANAESTHESIA
 
Upper limb blocks
Upper limb blocksUpper limb blocks
Upper limb blocks
 
Low flow Anesthesia system
Low flow  Anesthesia systemLow flow  Anesthesia system
Low flow Anesthesia system
 
Ultrasound guided truncal blocks
Ultrasound guided truncal blocksUltrasound guided truncal blocks
Ultrasound guided truncal blocks
 

Ähnlich wie Ultrasound-Guided Transversus Abdominis Plane Blocks

Journal club - Hernioplasty
Journal club - HernioplastyJournal club - Hernioplasty
Journal club - HernioplastyKIST Surgery
 
Journal club anastomosis
Journal club anastomosisJournal club anastomosis
Journal club anastomosisVeeru Reddy
 
Right care shared-decision-making-core-clinical-presentation-23-march2011
Right care shared-decision-making-core-clinical-presentation-23-march2011Right care shared-decision-making-core-clinical-presentation-23-march2011
Right care shared-decision-making-core-clinical-presentation-23-march2011ian.mckinnell
 
Retrosternal SZISACON anaesthesia periop
Retrosternal SZISACON anaesthesia periopRetrosternal SZISACON anaesthesia periop
Retrosternal SZISACON anaesthesia periopUmaKumar14
 
Gastrointestinal disorders
Gastrointestinal disordersGastrointestinal disorders
Gastrointestinal disordersRoma Bhatti
 
Impact of Different Surgical Protocols on Dimensional Changes of Free Soft Ti...
Impact of Different Surgical Protocols on Dimensional Changes of Free Soft Ti...Impact of Different Surgical Protocols on Dimensional Changes of Free Soft Ti...
Impact of Different Surgical Protocols on Dimensional Changes of Free Soft Ti...Dr. B.V.Parvathy
 
Acute Appendicitis
Acute AppendicitisAcute Appendicitis
Acute AppendicitisKIST Surgery
 
Gossypiboma: A Diagnostic Challenge but a Surgeon's Nightmare.
Gossypiboma: A Diagnostic Challenge but a Surgeon's Nightmare.Gossypiboma: A Diagnostic Challenge but a Surgeon's Nightmare.
Gossypiboma: A Diagnostic Challenge but a Surgeon's Nightmare.KETAN VAGHOLKAR
 
Trauma management in_primary_care_setting
Trauma management in_primary_care_settingTrauma management in_primary_care_setting
Trauma management in_primary_care_settingbausher willayat
 
Trauma Management in Primary Care Setting
Trauma Management in Primary Care SettingTrauma Management in Primary Care Setting
Trauma Management in Primary Care Settingssnsharifa
 
Journal Club on The clinical and radiographical characteristics of zygomatic ...
Journal Club on The clinical and radiographical characteristics of zygomatic ...Journal Club on The clinical and radiographical characteristics of zygomatic ...
Journal Club on The clinical and radiographical characteristics of zygomatic ...Dr Bhavik Miyani
 
Perioperative nursing care in critical care icu
Perioperative nursing care in critical care icuPerioperative nursing care in critical care icu
Perioperative nursing care in critical care icukhunteta
 
Efficacy of laparoscopically assisted high ligation of patent processus vagin...
Efficacy of laparoscopically assisted high ligation of patent processus vagin...Efficacy of laparoscopically assisted high ligation of patent processus vagin...
Efficacy of laparoscopically assisted high ligation of patent processus vagin...Hisham Ahmed,M.D,PhD,MRCS
 
Pre & post operative nursing care
Pre & post operative nursing carePre & post operative nursing care
Pre & post operative nursing careABHIJIT BHOYAR
 
Abdominal stab wound exploration
Abdominal stab wound explorationAbdominal stab wound exploration
Abdominal stab wound explorationRiezel Mangalino
 

Ähnlich wie Ultrasound-Guided Transversus Abdominis Plane Blocks (20)

Journal club - Hernioplasty
Journal club - HernioplastyJournal club - Hernioplasty
Journal club - Hernioplasty
 
Journal club anastomosis
Journal club anastomosisJournal club anastomosis
Journal club anastomosis
 
Right care shared-decision-making-core-clinical-presentation-23-march2011
Right care shared-decision-making-core-clinical-presentation-23-march2011Right care shared-decision-making-core-clinical-presentation-23-march2011
Right care shared-decision-making-core-clinical-presentation-23-march2011
 
Retrosternal SZISACON anaesthesia periop
Retrosternal SZISACON anaesthesia periopRetrosternal SZISACON anaesthesia periop
Retrosternal SZISACON anaesthesia periop
 
Ortho Journal Club 5 by Dr Saumya Agarwal
Ortho Journal Club 5 by Dr Saumya AgarwalOrtho Journal Club 5 by Dr Saumya Agarwal
Ortho Journal Club 5 by Dr Saumya Agarwal
 
Emergency room-report
Emergency room-reportEmergency room-report
Emergency room-report
 
Preoperative preparation
Preoperative preparationPreoperative preparation
Preoperative preparation
 
Gastrointestinal disorders
Gastrointestinal disordersGastrointestinal disorders
Gastrointestinal disorders
 
Nursing care of TAH patient
Nursing care of TAH patientNursing care of TAH patient
Nursing care of TAH patient
 
Impact of Different Surgical Protocols on Dimensional Changes of Free Soft Ti...
Impact of Different Surgical Protocols on Dimensional Changes of Free Soft Ti...Impact of Different Surgical Protocols on Dimensional Changes of Free Soft Ti...
Impact of Different Surgical Protocols on Dimensional Changes of Free Soft Ti...
 
Acute Appendicitis
Acute AppendicitisAcute Appendicitis
Acute Appendicitis
 
Gossypiboma: A Diagnostic Challenge but a Surgeon's Nightmare.
Gossypiboma: A Diagnostic Challenge but a Surgeon's Nightmare.Gossypiboma: A Diagnostic Challenge but a Surgeon's Nightmare.
Gossypiboma: A Diagnostic Challenge but a Surgeon's Nightmare.
 
Trauma management in_primary_care_setting
Trauma management in_primary_care_settingTrauma management in_primary_care_setting
Trauma management in_primary_care_setting
 
Trauma Management in Primary Care Setting
Trauma Management in Primary Care SettingTrauma Management in Primary Care Setting
Trauma Management in Primary Care Setting
 
Journal Club on The clinical and radiographical characteristics of zygomatic ...
Journal Club on The clinical and radiographical characteristics of zygomatic ...Journal Club on The clinical and radiographical characteristics of zygomatic ...
Journal Club on The clinical and radiographical characteristics of zygomatic ...
 
Perioperative nursing care in critical care icu
Perioperative nursing care in critical care icuPerioperative nursing care in critical care icu
Perioperative nursing care in critical care icu
 
Efficacy of laparoscopically assisted high ligation of patent processus vagin...
Efficacy of laparoscopically assisted high ligation of patent processus vagin...Efficacy of laparoscopically assisted high ligation of patent processus vagin...
Efficacy of laparoscopically assisted high ligation of patent processus vagin...
 
St. Joseph's University Medical Center
St. Joseph's University Medical CenterSt. Joseph's University Medical Center
St. Joseph's University Medical Center
 
Pre & post operative nursing care
Pre & post operative nursing carePre & post operative nursing care
Pre & post operative nursing care
 
Abdominal stab wound exploration
Abdominal stab wound explorationAbdominal stab wound exploration
Abdominal stab wound exploration
 

Mehr von Md Rabiul Alam

করোনা পরিস্থিতি এবং প্রাথমিক ও মাধ্যমিক শিক্ষা কার্যক্রম
করোনা পরিস্থিতি এবং প্রাথমিক ও মাধ্যমিক শিক্ষা কার্যক্রমকরোনা পরিস্থিতি এবং প্রাথমিক ও মাধ্যমিক শিক্ষা কার্যক্রম
করোনা পরিস্থিতি এবং প্রাথমিক ও মাধ্যমিক শিক্ষা কার্যক্রমMd Rabiul Alam
 
Medical Prognostication
Medical PrognosticationMedical Prognostication
Medical PrognosticationMd Rabiul Alam
 
Good health Good life: Bankers perspective
Good health Good life: Bankers perspectiveGood health Good life: Bankers perspective
Good health Good life: Bankers perspectiveMd Rabiul Alam
 
Surg safety checklist: Revisited
Surg safety checklist: RevisitedSurg safety checklist: Revisited
Surg safety checklist: RevisitedMd Rabiul Alam
 
Endpoints of Resuscitation
Endpoints of ResuscitationEndpoints of Resuscitation
Endpoints of ResuscitationMd Rabiul Alam
 
Perioperative considerations for OSA in Children
Perioperative considerations for OSA in ChildrenPerioperative considerations for OSA in Children
Perioperative considerations for OSA in ChildrenMd Rabiul Alam
 
Anesthetic Management of a Patient with Peripartum Cardiomyopathy for LUCS
Anesthetic Management of a Patient with Peripartum Cardiomyopathy for LUCSAnesthetic Management of a Patient with Peripartum Cardiomyopathy for LUCS
Anesthetic Management of a Patient with Peripartum Cardiomyopathy for LUCSMd Rabiul Alam
 
Anaesthesia for Kidney Transplant
Anaesthesia for Kidney TransplantAnaesthesia for Kidney Transplant
Anaesthesia for Kidney TransplantMd Rabiul Alam
 
Anaestehsia for Cesarean section in a patient with Central Placenta Previa wi...
Anaestehsia for Cesarean section in a patient with Central Placenta Previa wi...Anaestehsia for Cesarean section in a patient with Central Placenta Previa wi...
Anaestehsia for Cesarean section in a patient with Central Placenta Previa wi...Md Rabiul Alam
 
Preoperative Incidental Detection & Anaesthetic Management of Valvular Heart ...
Preoperative Incidental Detection & Anaesthetic Management of Valvular Heart ...Preoperative Incidental Detection & Anaesthetic Management of Valvular Heart ...
Preoperative Incidental Detection & Anaesthetic Management of Valvular Heart ...Md Rabiul Alam
 
Anaesthetic Management of Elderly Patients
Anaesthetic Management of Elderly PatientsAnaesthetic Management of Elderly Patients
Anaesthetic Management of Elderly PatientsMd Rabiul Alam
 
Anaesthetic Management of a Patient with HELLP Syndrome
Anaesthetic Management of a Patient with HELLP SyndromeAnaesthetic Management of a Patient with HELLP Syndrome
Anaesthetic Management of a Patient with HELLP SyndromeMd Rabiul Alam
 

Mehr von Md Rabiul Alam (13)

করোনা পরিস্থিতি এবং প্রাথমিক ও মাধ্যমিক শিক্ষা কার্যক্রম
করোনা পরিস্থিতি এবং প্রাথমিক ও মাধ্যমিক শিক্ষা কার্যক্রমকরোনা পরিস্থিতি এবং প্রাথমিক ও মাধ্যমিক শিক্ষা কার্যক্রম
করোনা পরিস্থিতি এবং প্রাথমিক ও মাধ্যমিক শিক্ষা কার্যক্রম
 
Medical Prognostication
Medical PrognosticationMedical Prognostication
Medical Prognostication
 
Good health Good life: Bankers perspective
Good health Good life: Bankers perspectiveGood health Good life: Bankers perspective
Good health Good life: Bankers perspective
 
Surg safety checklist: Revisited
Surg safety checklist: RevisitedSurg safety checklist: Revisited
Surg safety checklist: Revisited
 
Endpoints of Resuscitation
Endpoints of ResuscitationEndpoints of Resuscitation
Endpoints of Resuscitation
 
Perioperative considerations for OSA in Children
Perioperative considerations for OSA in ChildrenPerioperative considerations for OSA in Children
Perioperative considerations for OSA in Children
 
Anesthetic Management of a Patient with Peripartum Cardiomyopathy for LUCS
Anesthetic Management of a Patient with Peripartum Cardiomyopathy for LUCSAnesthetic Management of a Patient with Peripartum Cardiomyopathy for LUCS
Anesthetic Management of a Patient with Peripartum Cardiomyopathy for LUCS
 
Intranasal Midazolam
Intranasal MidazolamIntranasal Midazolam
Intranasal Midazolam
 
Anaesthesia for Kidney Transplant
Anaesthesia for Kidney TransplantAnaesthesia for Kidney Transplant
Anaesthesia for Kidney Transplant
 
Anaestehsia for Cesarean section in a patient with Central Placenta Previa wi...
Anaestehsia for Cesarean section in a patient with Central Placenta Previa wi...Anaestehsia for Cesarean section in a patient with Central Placenta Previa wi...
Anaestehsia for Cesarean section in a patient with Central Placenta Previa wi...
 
Preoperative Incidental Detection & Anaesthetic Management of Valvular Heart ...
Preoperative Incidental Detection & Anaesthetic Management of Valvular Heart ...Preoperative Incidental Detection & Anaesthetic Management of Valvular Heart ...
Preoperative Incidental Detection & Anaesthetic Management of Valvular Heart ...
 
Anaesthetic Management of Elderly Patients
Anaesthetic Management of Elderly PatientsAnaesthetic Management of Elderly Patients
Anaesthetic Management of Elderly Patients
 
Anaesthetic Management of a Patient with HELLP Syndrome
Anaesthetic Management of a Patient with HELLP SyndromeAnaesthetic Management of a Patient with HELLP Syndrome
Anaesthetic Management of a Patient with HELLP Syndrome
 

Kürzlich hochgeladen

Radiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptxRadiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptxDr. Dheeraj Kumar
 
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)MohamadAlhes
 
CEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand University
CEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand UniversityCEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand University
CEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand UniversityHarshChauhan475104
 
The next social challenge to public health: the information environment.pptx
The next social challenge to public health:  the information environment.pptxThe next social challenge to public health:  the information environment.pptx
The next social challenge to public health: the information environment.pptxTina Purnat
 
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxSYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxdrashraf369
 
Rheumatoid arthritis - Musculoskeletal disorders.ppt
Rheumatoid arthritis - Musculoskeletal disorders.pptRheumatoid arthritis - Musculoskeletal disorders.ppt
Rheumatoid arthritis - Musculoskeletal disorders.pptraviapr7
 
Culture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptxCulture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptxDr. Dheeraj Kumar
 
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurMETHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurNavdeep Kaur
 
SGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdf
SGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdfSGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdf
SGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdfHongBiThi1
 
COVID-19 (NOVEL CORONA VIRUS DISEASE PANDEMIC ).pptx
COVID-19  (NOVEL CORONA  VIRUS DISEASE PANDEMIC ).pptxCOVID-19  (NOVEL CORONA  VIRUS DISEASE PANDEMIC ).pptx
COVID-19 (NOVEL CORONA VIRUS DISEASE PANDEMIC ).pptxBibekananda shah
 
Systemic Lupus Erythematosus -SLE PT2.ppt
Systemic  Lupus  Erythematosus -SLE PT2.pptSystemic  Lupus  Erythematosus -SLE PT2.ppt
Systemic Lupus Erythematosus -SLE PT2.pptraviapr7
 
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...Badalona Serveis Assistencials
 
HERBS AS HEALTH FOOD - Brief introduction and therapeutic applications of: N...
HERBS AS HEALTH FOOD - Brief introduction and therapeutic applications of:  N...HERBS AS HEALTH FOOD - Brief introduction and therapeutic applications of:  N...
HERBS AS HEALTH FOOD - Brief introduction and therapeutic applications of: N...Divya Kanojiya
 
CCSC6142 Week 3 Research ethics - Long Hoang.pdf
CCSC6142 Week 3 Research ethics - Long Hoang.pdfCCSC6142 Week 3 Research ethics - Long Hoang.pdf
CCSC6142 Week 3 Research ethics - Long Hoang.pdfMyThaoAiDoan
 
World-Health-Day-2024-My-Health-My-Right.pptx
World-Health-Day-2024-My-Health-My-Right.pptxWorld-Health-Day-2024-My-Health-My-Right.pptx
World-Health-Day-2024-My-Health-My-Right.pptxEx WHO/USAID
 
SCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna ThakurSCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna ThakurSapna Thakur
 
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic AnalysisVarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic AnalysisGolden Helix
 
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfSGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfHongBiThi1
 
Tans femoral Amputee : Prosthetics Knee Joints.pptx
Tans femoral Amputee : Prosthetics Knee Joints.pptxTans femoral Amputee : Prosthetics Knee Joints.pptx
Tans femoral Amputee : Prosthetics Knee Joints.pptxKezaiah S
 
Screening for colorectal cancer AAU.pptx
Screening for colorectal cancer AAU.pptxScreening for colorectal cancer AAU.pptx
Screening for colorectal cancer AAU.pptxtadehabte
 

Kürzlich hochgeladen (20)

Radiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptxRadiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptx
 
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
 
CEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand University
CEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand UniversityCEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand University
CEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand University
 
The next social challenge to public health: the information environment.pptx
The next social challenge to public health:  the information environment.pptxThe next social challenge to public health:  the information environment.pptx
The next social challenge to public health: the information environment.pptx
 
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxSYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
 
Rheumatoid arthritis - Musculoskeletal disorders.ppt
Rheumatoid arthritis - Musculoskeletal disorders.pptRheumatoid arthritis - Musculoskeletal disorders.ppt
Rheumatoid arthritis - Musculoskeletal disorders.ppt
 
Culture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptxCulture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptx
 
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurMETHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
 
SGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdf
SGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdfSGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdf
SGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdf
 
COVID-19 (NOVEL CORONA VIRUS DISEASE PANDEMIC ).pptx
COVID-19  (NOVEL CORONA  VIRUS DISEASE PANDEMIC ).pptxCOVID-19  (NOVEL CORONA  VIRUS DISEASE PANDEMIC ).pptx
COVID-19 (NOVEL CORONA VIRUS DISEASE PANDEMIC ).pptx
 
Systemic Lupus Erythematosus -SLE PT2.ppt
Systemic  Lupus  Erythematosus -SLE PT2.pptSystemic  Lupus  Erythematosus -SLE PT2.ppt
Systemic Lupus Erythematosus -SLE PT2.ppt
 
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
 
HERBS AS HEALTH FOOD - Brief introduction and therapeutic applications of: N...
HERBS AS HEALTH FOOD - Brief introduction and therapeutic applications of:  N...HERBS AS HEALTH FOOD - Brief introduction and therapeutic applications of:  N...
HERBS AS HEALTH FOOD - Brief introduction and therapeutic applications of: N...
 
CCSC6142 Week 3 Research ethics - Long Hoang.pdf
CCSC6142 Week 3 Research ethics - Long Hoang.pdfCCSC6142 Week 3 Research ethics - Long Hoang.pdf
CCSC6142 Week 3 Research ethics - Long Hoang.pdf
 
World-Health-Day-2024-My-Health-My-Right.pptx
World-Health-Day-2024-My-Health-My-Right.pptxWorld-Health-Day-2024-My-Health-My-Right.pptx
World-Health-Day-2024-My-Health-My-Right.pptx
 
SCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna ThakurSCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
 
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic AnalysisVarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
 
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfSGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
 
Tans femoral Amputee : Prosthetics Knee Joints.pptx
Tans femoral Amputee : Prosthetics Knee Joints.pptxTans femoral Amputee : Prosthetics Knee Joints.pptx
Tans femoral Amputee : Prosthetics Knee Joints.pptx
 
Screening for colorectal cancer AAU.pptx
Screening for colorectal cancer AAU.pptxScreening for colorectal cancer AAU.pptx
Screening for colorectal cancer AAU.pptx
 

Ultrasound-Guided Transversus Abdominis Plane Blocks

  • 1. Welcome to the US-guided nerve blocks training programme Ultrasound-Guided Transversus Abdominis Plane Blocks Institute of Pain Medicine & Research Centre Dept of Anaesthesia & Pain Medicine Evercare Hospital Dhaka Lt Col (Retd) Dr Md Rabiul Alam Senior Consultant Dept of Anaesthesia & Pain Medicine Evercare Hospital Dhaka
  • 2. Objectives • Identifying the patients who would benefit from Transversus Abdominis Plane (TAP) blocks • Relevant anatomy associated with TAP blocks • Several techniques to approach TAP blocks • Importance of an interprofessional team
  • 3. Importance • A rise in opioid-related adverse effects and death has led to a surge in utilizing alternative methods to treat pain
  • 4. Opioid-related deaths Ref: Kaplovitch E, Gomes T, Camacho X, Dhalla IA, Mamdani MM, Juurlink DN (2015) Sex Differences in Dose Escalation and Overdose Death during Chronic Opioid Therapy: A Population-Based Cohort Study. PLoS ONE 10(8): e0134550. doi:10.1371/ journal.pone.0134550
  • 5. Opioid-related deaths… Ref: Gomes T, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. The Burden of Opioid-Related Mortality in the United States. JAMA Netw Open. 2018 Jun 1;1(2):e180217. doi: 10.1001/jamanetworkopen.2018.0217.
  • 6. Introduction… • US-guided RA parallels the rapid rise in availability of US machines • Abdominal wall is a common source of pain after abdominal surgeries • US-guided TAP blocks provide reliable relief of somatic incisional pain • A great adjunct to a multimodal analgesic regimen • Spares visceral pain relief(!), necessitate additional analgesic modes • Creates a non-dermatomal field block
  • 7. History Ahmed Nadeem Rafi, MD Institute of Interventional Pain Management Russellville, Arkansas, United States Ref: Rafi A. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 2001; 56: 1024- 26
  • 8. History… Ref: Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007 Aug;35(4):616-7
  • 9. Indications • Major abdominal surgeries • Colorectal surgeries - alternative to epidural anaesthesia(!) • Hernia repairs • Procedures involving the abdominal wall • Cesarean section • Appendectomy, abdominal hysterectomy, abdominoplasty, prostatectomy • Laparoscopic surgeries
  • 10. Contraindications • Patient refusal • Active infection over the site of injection • Practice caution in patients • Taking anticoagulation • Pregnant patient • Patients where anatomical landmarks are indistinguishable • Avoid local anesthetics in those with known allergies
  • 11. Anatomy • The anterolateral abdominal wall is bound • Laterally by the posterior axillary lines • Superiorly: • costal margin of the 7th to 10th ribs • xiphoid process • Inferiorly: • Iliac crest • Inguinal ligament • Pubic crest • Symphysis
  • 12. Anatomy… muscles • The muscles of the anterolateral abdominal wall, from superficial to deep • External oblique • Internal oblique • Transversus abdominis • TAP is the fascial plane that separates the TA from the IO muscle
  • 13. Anatomy… nerves • Innervation of the anterolateral abdominal wall is composed of • Thoracoabdominal nerves • Ilioinguinal • Iliohypogastric nerves which communicate to form the upper and lower TAP plexuses
  • 14. Anatomy… nerves • T6 entering just lateral to the linea alba • T7-T9 enter the TAP medial to the anterior axillary line • T10-T12 nerves enter more laterally and can be blocked in the midaxillary line between the bottom of the thoracic cage and the top of the iliac crest
  • 15. Requirements • US machine with a high frequency probe (10-5 MHz), linear, curvelinear • US probe cover • Antiseptic for skin disinfection • Sterile ultrasound gel • Needle: 50/80/100 mm needles • 10/20ml syringes and injection tubing • 40 to 60 ml local anaesthetic (this block relies on local anaesthetic spread rather than concentration, i.e. is volume dependent)
  • 16. Personnel • Trained and skilled medical providers, including anesthesiologists, can perform TAP blocks • Typically a second healthcare provider or nurse is required for time- out before starting the procedure, and to assist with the injection of local anesthetic
  • 17. Preparations • Discuss risks, benefits, alternatives with the patient & obtain informed consent • Monitoring: ECG, SpO2, and BP every 5 minutes • IV access • Position the patient supine and uncover the abdomen • Be sure to thoroughly clean the skin over the anterolateral abdomen, from the costal margin to iliac crest, followed by placement of sterile towels surrounding the border of the procedural field • A procedural time-out should take place prior to starting the procedure
  • 18. Types of TAP blocks • Subcostal • Lateral • Posterior • Anterior (iliohypogastric & ilioinguinal nerves block) Plus • Rectus Sheath nerve blocks
  • 22. Anterior (IH & II nerves) Distribution of block: hypogastric region, inguinal crease, upper medial thigh, mons pubis, part of labia, root of the penis, & anterior part of the scrotum
  • 23. Rectus sheath nerve block Distribution of block: periumbilical area (spinal dermatomes 9, 10, & 11)
  • 24. Complications • Field blocks are safer, neurological injury is rare • Nerve trauma, hematoma • Intraperitoneal injection, visceral trauma, vascular injury, and liver trauma • Transient femoral nerve palsy • Essential to well visualizing the LA injection within TAP • Be cautious to avoid vascular puncture and intravascular injection • LA systemic toxicity is a rare but known complication
  • 25. Team approach… • A team-based, interprofessional methodology • Communication with the surgeon • Location of the incision, timing of the block, and other unique considerations • Time-out to promote patient safety • Verbal contact with the patient throughout the procedure • Extreme caution when handling sharps as accidental needle sticks may occur • Sharps require disposal using appropriately marked bins • Documentations
  • 26. Organizational initiatives • An interprofessional team: clinicians (both general & specialists), nurses, surgical assistants, and pharmacists • Clinicians should send the patient to the specialists, who will prepare the patient for the procedure in conjunction with the nursing staffs • The pharmacy will prepare the anesthetic and can act as a resource for any medication- related questions by the team • Nursing will assist during the procedure, and additional nursing duties • Interprofessional team will optimize the results from a TAP block leading to better patient outcomes
  • 27. Nursing assistance • Nurse is in charge of setting up the instrument tray for the block • Nurse may position and prep the patient for the procedure • Nurse is also responsible for making sure that the patient has signed consent • And that the procedure is taking place on the correct side of the abdominal pathology
  • 28. Nursing assistance… • Before starting the procedure, the nurse must make sure that resuscitative equipment is in the room • One nurse should be dedicated to the monitoring of the patient during and after the procedure • In the recovery room, the nurse should assess the patient's hemodynamic status and evaluated the site of the block for bleeding
  • 29. Take-home messages • Selection of appropriate candidates • Preparations of patients, OR/procedural room & ancilliaries • Skills & perfections for good outcomes • Development of an organized team & patients’ safety net • Obtaining adequate peers’ & administrative supports • Rational projections & marketing for viability
  • 30. Conclusion • TAP blocks have become an important addition to multimodal pain management for abdominal wall surgery • The safety, ease, and effectiveness of the block make it an excellent adjunct to perioperative pain management
  • 31. References 1. Kaplovitch E, Gomes T, Camacho X, Dhalla IA, Mamdani MM, Juurlink DN (2015) Sex Differences in Dose Escalation and Overdose Death during Chronic Opioid Therapy: A Population-Based Cohort Study. PLoS ONE 10(8): e0134550 2. Gomes T, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. The Burden of Opioid-Related Mortality in the United States. JAMA Netw Open. 2018 Jun 1;1(2):e180217 3. Rafi A. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 2001; 56: 1024- 26 4. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007 Aug;35(4):616-7 5. Hammi C, Ahn K. Transversus Abdominis Plane Block. [Updated 2022 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547730/ 6. Mukhtar K. Transversus Abdominis Plane (TAP) block. The Journal of NYSORA 2009; 12: 28-33 7. Elsharkawy H, Bendtsen TF. Ultrasound-Guided Transversus Abdominis Plane and Quadratus Lumborum Nerve Blocks. https://www.nysora.com/topics/regional-anesthesia-for-specific-surgical-procedures/abdomen/ultrasound-guided-transversus- abdominis-plane-quadratus-lumborum-blocks/ (Accessed on 12 June 2022)