Abstract
ObjectivesTo describe the ultrasound-guided transversus abdominis plane (TAP) block using a subcostal oblique approach in dog cadavers and to evaluate the spread of a methylene blue solution using a multiple-injection technique. Study designProspective, descriptive, experimental anatomic study. AnimalsNine adult Beagle cadavers weighing a mean ± standard deviation of 13 ± 2 kg. MethodsMethylene blue solution (10.0 mL) was injected bilaterally within the fascia that overlies the transversus abdominis muscle in dog cadavers under ultrasound guidance. A total of three injections (3.3 mL each) were administered on each side by the same operator. Dissection was performed by a second operator 20 minutes later. Successful nerve staining was defined as the presence of dye on the nerve for a length of >1 cm. ResultsVentral branches of the T9, T10, T11, T12 and T13 nerves innervating the cranial abdominal wall were stained in 72%, 95%, 100%, 95% and 61% of cases, respectively. Ventral branches of L1 and L2 innervating the caudal abdominal wall were stained in only 33% and 11% of cases, respectively. The dye was found only in the fascia between the transversus abdominis and the internal oblique muscles. Conclusions and clinical relevanceThe ultrasound-guided subcostal oblique TAP block provided adequate staining of the sensory innervation of the cranial abdominal wall. Further studies are required to evaluate the efficacy of this technique in blocking the nociceptive response in clinical procedures.
Highlights
The canine abdominal wall is innervated cranially by the ventromedial branches of T11, T12, T13 nerves andcaudally by L1, L2 and L3 nerves (Evans, 1993)
Local anaesthetic must be administered in the fascia between the internal oblique and transversus abdominis muscles where the ventral branches of the spinal nerves are located
The previously described sonographic landmarks required to perform transversus abdominis plane (TAP) block using this approach were identified in all hemispheres
Summary
The canine abdominal wall is innervated cranially by the ventromedial branches of T11, T12, T13 nerves andcaudally by L1, L2 and L3 nerves (Evans, 1993). The transversus abdominis plane (TAP) block is a regional anaesthesia technique designed to desensitize the nerves innervating abdominal muscles, abdominal subcutaneous tissue and parietal peritoneum. Local anaesthetic must be administered in the fascia between the internal oblique and transversus abdominis muscles where the ventral branches of the spinal nerves are located. Several approaches for ultrasound (US)-guided TAP block have been described, such as: subcostal oblique, mid-axillary and posterior approach (Carney at al.2011). The anterior approach, known as a subcostal oblique approach, was described by Hebbard (Hebbard 2010). This technique was developed to block ventral branches of T9 to T12 nerves in order to provide somatic analgesia for supraumbilical abdominal surgeries
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