区域麻醉在产科的运用Fingerman__培训课件.ppt

TAP Block Injection Ext. Oblique Local Trans. Abdominis Peritoneal Cavity Int. Oblique Needle TAP Anatomy-Discoveries: Nerves of T6-T9 enter the TAP medial to the anterior axillary line T6 enters the TAP just lateral to the linea alba T7-T9 enter at progressively increasing distances from the linea alba Nerves running in the TAP lateral to the anterior axillary line are T9-L1 segmental nerve This may explain why the classic TAP is only suitable for lower abdominal surgery In addition, extensive branching and communication was discovered (The “TAP plexus” of T9 to L1)-explains the power of a single injection Rozen WM, Tran TM, Ashton MW, et al. Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall. Clin Anat 2008; 21(4):325. Rozen WM, Tran TM, Ashton MW, et al. Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall. Clin Anat 2008; 21(4):325. “TAP PLEXUS” Headscratching ensued…  Hebbard P. Subcostal transversus abdominis plane block under ultrasound guidance. Anesth Analg 2008;106(2): 674. TAP Schematic- Subcostal Approach: Hebbard PD et al. Ultrasound-Guided Continuous Oblique Subcostal Transversus Abdominis Plane Blockade: Description of Anatomy and Clinical Technique. Regional Anesthesia and Pain Medicine. Volume 35(5): 436-41. Varying U/S Views- Subcostal Approach: Hebbard PD et al. Ultrasound-Guided Continuous Oblique Subcostal Transversus Abdominis Plane Blockade: Description of Anatomy and Clinical Technique. Regional Anesthesia and Pain Medicine. Volume 35(5): 436-41. TAP Technique- Subcostal Approach: Patient supine; 15 cm needle with curved tip useful Identify the rectus abdominis near the costal margin in transverse view Slide the probe laterally to locate the transversus plane after passing the lateral edge of rectus 10 ml of LA solution to extend coverage of posterior TAP 20 ml when subcostal block don