Premium
Ultrasound‐guided bilateral dual transversus abdominis plane block: a new four‐point approach
Author(s) -
BØRGLUM J.,
MASCHMANN C.,
BELHAGE B.,
JENSEN K.
Publication year - 2011
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2011.02430.x
Subject(s) - medicine , anesthesia , visual analogue scale , bupivacaine , ultrasound , surgery , general anaesthesia , block (permutation group theory) , prospective cohort study , radiology , geometry , mathematics
Background: We describe a new ultrasound‐guided bilateral dual transversus abdominis plane block. Our hypothesis was that we could anaesthetize both the upper (Th6–Th9) and the lower (Th10–Th12) abdominal wall bilaterally using a four‐point single‐shot technique to provide effective post‐operative analgesia. Methods: A prospective cohort of 25 recovery room patients was included. They had undergone major open or laparoscopic abdominal surgery under general anaesthesia and had severe post‐operative pain. The blocks were conducted using a high‐frequency linear transducer and a 22 G, 80‐mm‐long needle. The needle was inserted in‐plane from medial to lateral for each injection. Fifteen millilitres of bupivacaine 2.5 mg/ml was injected at each of the four sites. Results: Block performance took on average 16 min (range 10–20 min). The 25 patients reported a reduction of their maximum pain (visual analogue scale 0–10) from a mean of 8.2 to a mean of 2.2 10 min after block performance ( P <0.001). They were discharged from the post‐anaesthesia care unit after an average of 34 min. Twenty‐one patients (84%) did not require any i.v. opioids in the following 6 h. Sixteen patients (64%) were mobilized within 6 h after the block. Data were similar irrespective of open or laparoscopic surgery ( P =0.68). Conclusion: This new four‐point single‐shot technique was effective in decreasing severe pain after a major abdominal surgery. The block, although short‐lived, facilitated discharge from the post‐anaesthesia care unit, few patients required opioids on the day of surgery and mobilization was improved.