Rectus Sheath and Transversus Abdominis Plane (TAP) Blocks

Abstract

In the pediatric population, caudal epidural anesthesia has been the mainstay of providing pain control for gastrointestinal and abdominal surgeries. However, the increased prevalence of ultrasound has allowed more practitioners to administer targeted nerve blocks for these surgeries. Pain following abdominal surgery is largely derived from the abdominal wall incision; ultrasound-guided rectus sheath and transversus abdominis plane (TAP) blocks have proven beneficial for controlling this pain while reducing the risks, side effects, and effort that associated with epidural blockade. The rectus sheath block is generally used for any midline abdominal incisions (i.e., umbilical and epigastric hernia repairs) and is valuable in the outpatient setting. The aim during the block is to deposit local anesthetic between the rectus abdominis muscle and the posterior wall of the rectus sheath. If longer-duration analgesia is desired, a rectus sheath catheter can be inserted. Similarly, TAP blocks are used for anesthesia of nerves supplying the anterior abdominal wall and are commonly used in procedures such as bowel resection, appendectomy, and renal transplant. As with rectus sheath blocks, a TAP catheter(s) can be placed either by ultrasound guidance or direct vision by the surgeon to achieve longer-lasting analgesia. Landmark- and ultrasound-guided approaches to rectus sheath and TAP blocks are described in this chapter.