Stephan Kapral from Vienna was the first who presented an US guided nerve block with real-time visualisation of the target nerves and the perineural spread of local anaesthetic
It was a supraclavicular brachial plexus block
Kapral S, Kraff P, Eibenberger K, Fitzgerald R, Gosh M, Weinstabl C: Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesthesia & Analgesia, 78:507-513 (1994)
The supraclavicular brachial plexus block is indicated for surgical anaesthesia and postoperative analgesia for procedures of the upper limb distal to the shoulder level
The first transcutaneous, supraclavicular brachial plexus block in history was performed approximately 100 years ago
The supraclavicular brachial plexus block targets the brachial plexus at the level of the zone of transition – where the trunks are transformed to fascicles just proximal to the clavicle
The Bilateral Dual TAP block (BD-TAP block) is a combination of four TAP blocks
Together the four blocks anesthetise the entire antero-lateral abdominal wall including the parietal peritoneum – but excluding the visceral peritoneum: Bilateral intercostal TAP block combined with bilateral classic TAP block
The indications for the BD-TAP block are:
– Perioperative pain management for abdominal surgery
– Post-operative rescue pain management after abdominal surgery
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You have now completed the e-course about the basic ultrasound guided peripheral nerve blocks
You have fulfilled the following learning objectives:
– Understanding the basic anatomy and sonoanatomy of the basic nerve blocks
– Knowing how to perform each of the basic nerve blocks
– Knowing about the pitfalls
Now you are ready to join the hands-on training
Lower abdomen (Th10-Th12/L1) – the classic TAP block: Place the transducer above the iliac crest and below the thoracic cage
Identify the external and internal oblique muscles and the underlying transversus abdominis muscle
The needle insertion point on the skin should be in the anterior axillary line.
Insert the needle in-plane to the transducer and advance in a lateral and posterior direction
The end-point will be in the neurovascular fascial plane between the internal oblique muscle and the transversus abdominis muscle
Inject 15 ml ropivacaine 0.375% at each of the four points of the BD-TAP block (for adults)
The anterior rami of spinal nerves Th6 to L1 innervate the antero-lateral abdominal wall. They include the intercostal (Th6-Th11), the subcostal (Th12), and the iliohypogastric/ilioinguinal nerves (L1)
These nerves give rise to lateral cutaneous branches in the neurovascular plane called the transversus abdominis plane (TAP) between the internal oblique and the transversus abdominis muscles
Th6-Th12 pierce the rectus sheath and end as anterior cutaneous nerves. They provide sensory innervation to the skin, costal parts of diaphragm, related parietal pleura and the parietal peritoneum
Th6-7 give sensory innervation at the epigastrium, Th10 at the umbilicus, and L1 at the groin
Th6-L1 contribute motor innervation to overlying oblique muscles, the transversus abdominus muscle, the pyramidalis and the rectus abdominis muscle
