Laparoscopic Assisted Posterior Transverse Abdominis Plane (Tap) Block

Abstract

Video Objective This video demonstrates a laparoscopic assisted transverse abdominis plane (TAP) block as an alternative to the traditional anesthesiology-driven ultrasound-guided TAP block to reduce postoperative pain. Setting Our patient is a 49 year old with endometriosis, abnormal uterine bleeding, and fibroids, who undergoes a total laparoscopic hysterectomy. Interventions Following removal of the specimen and closure of the vaginal cuff, we inject a mixture of liposomal bupivacaine and regular bupivacaine between the transverse abdominis and internal oblique muscles. We use external and internal anatomic landmarks such as the iliac crest, latissimus dorsi muscle, and the transverse abdominis muscle to target the Triangle of Petit when placing the injection under direct visualization. This supplies analgesia to the parietal peritoneum, skin, and muscles along T8 through L1 dermatomes. The patient did not require any postoperative opioid based medications. Conclusion The laparoscopic assisted TAP block is a safe, effective, and quick strategy to reduce pain after minimally invasive gynecologic surgery.