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• W1984650832 abstract "Børglum et al. propose a division of transversus abdominis plexus (TAP) block nomenclature into ‘upper’ and ‘lateral’ zones with ‘dual’ TAP blocks being injections into both zones 1. The use of ‘posterior’ in this scheme is reserved for the injection through the triangle of Petit. Nomenclature involving the triangle of Petit in relation to abdominal wall blockade has been confused from the start. In their landmark 2007 paper, McDonnell et al. described a block via the triangle of Petit using illustra-tions, computed tomography (CT) and magnetic resonance images 2. Unfortunately, the triangle was incorrectly illustrated in the lateral rather than posterior abdominal wall. The injection sites were also positioned laterally, particular for the subject in the CT image who received an injection centred anteriorly to the mid-axillary line. Jankovic et al. showed the anterior and middle parts of the triangle of Petit to be on average 5.8 cm and 9.3 cm posterior to the mid-axillary line, respectively 3. As originally described, therefore, it is not possible to inject perpendicular to the triangle of Petit without rolling the patient onto his/her side. In many patients, the skin over the lumbar triangle of Petit is in contact with the mattress when positioned supine. I co-authored the first description of ultrasound-guided TAP block in 2007 4, and was aware of McDonnell et al.'s detailed description of the triangle of Petit landmark technique at the time of writing. When it became apparent that posterior block did not spread well above the umbilicus, I described a ‘subcostal’ approach to improve spread 5, the term being used in the surgical sense as in subcostal (Kocher's) incision, rather than in reference to the subcostal nerve. ‘Subcostal oblique’ was used to define the passage of the needle along the costal margin, enabling a catheter to be placed, producing a more extensive block across the line of the nerves. Børglum and colleagues propose that we should drop the use of ‘subcostal’ to avoid confusion with the subcostal nerve, but I do not think this a strong argument as the term has been in use in the literature for six years and correlates with the surgical anatomy. ‘Intercostal’ has also been used to refer to the subcostal location, which makes less sense since intercostal block already exists, and almost all blocks into the TAP block the intercostal nerves even though the block is not in the intercostal space. Lee at al. first used ‘posterior’ to define a separate TAP location in 2010 when comparing the lateral site with a subcostal injection 6, more clearly locating ‘lateral’ as ‘posterior’ in this context. It is clear that location of injection into the TAP alters the spread and effect of TAP blocks. I propose the range of TAP injections should be classified as follows (Fig. 4): This proposed scheme describes five distinct areas that have a different distribution of blockade. Within this scheme terms such as ‘dual’ or ‘four quadrant’ TAP blocks may refer to injection into the upper subcostal and lateral areas, and ‘subcostal oblique’ to a single injection passing through the upper and lower subcostal TAP to the ilio-inguinal TAP area." @default.
• W1984650832 created "2016-06-24" @default.
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• W1984650832 date "2014-12-09" @default.
• W1984650832 modified "2023-10-16" @default.
• W1984650832 title "TAP block nomenclature" @default.
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• W1984650832 doi "https://doi.org/10.1111/anae.12970" @default.
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