2751 A New Approach to the 4-Point Transversus Abdominis Plane Block

Abstract

Study Objective To educate gynecologic surgeons on the background, indications, technique, and outcomes of a four-point transversus abdominis plane (TAP) block delivered under laparoscopic guidance. Design We devised a technique for a laparoscopic assisted four-point TAP block. We have described the indications, supplies needed, and medications administered. We performed a cadaveric dissection of the anterior-lateral abdominal wall to identify the neurovascular plane used for anesthetic injection. To the best of our knowledge, we are the first to perform a four-point TAP block at the subcostal and lateral positions, under laparoscopic visualization, for robotic-assisted gynecologic procedures including hysterectomies. Setting Academic community hospital setting and institutional cadaver lab. Patients or Participants N/A Interventions We perform laparoscopic assisted four-point TAP blocks on all robotic-assisted gynecologic procedures unless there is a contraindication. Blocks are placed by the surgeon after insertion of the laparoscope. For the subcostal injection the lower costal margin is palpated, and the injection site is identified two centimeters inferior and medial to the mid-axillary line. For the inferior injection the anterior superior iliac spine is palpated, and the injection is two centimeters superior and medial to the mid-axillary line. Introduction of a regional anesthesia needle is simultaneously observed externally and laparoscopically. This method along with detailed anatomical landmarks are described in our technique paper. Measurements and Main Results N/A Conclusion A four-point TAP block is a safe, efficacious, yet simple procedure which can be performed by the surgeon under laparoscopic visualization.