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- W2890121022 abstract "We thank Dr. Gucev for his interest in our paper 1. The diagram in Fig. 3 was used to illustrate the notional course of the nerves to aid readers in visualisation of the anatomical relationships for this hybrid block. Jamison et al. nicely demonstrated that the point where the nerves penetrate the TAP plane is variable and can be as posterior as the posterior superior iliac spine and as anterior as the anterior superior iliac spine 2. We agree that this variable anatomy may explain the mix of positive and negative trials using either TAP or ilioinguinal–iliohypogastric blocks individually 3, 4. All caesarean sections were performed via a Pfannenstiel incision. While the typical Pfannenstiel incision should be within the L1 dermatome, the pain from the procedure can affect mixed nerve distributions. For example, there is blunt dissection and traction of the rectus abdominis and pyramidalis muscles between the symphysis and umbilicus 5, which may involve the thoracolumbar and subcostal nerve (T10–T12). There is also the unknown factor of operator variability in the placement of the incision. Again, these are all factors that may contribute to the variable outcomes of trials involving the individual blocks. We sought a technique that would overcome the variable anatomy and broaden the sensory coverage of these blocks. We believe the I-TAP block provides more reliable blockade of the ilio-inguinal–iliohypogastric nerves by targeting them at different sites along their course, broadens the area of sensory blockade with the fascial compartment block provided by the TAP injection and simplifies the technique by utilising one pass rather than multiple needle passes. We have demonstrated that the block is efficacious; its effectiveness compared with the individual blocks would be an excellent direction for further research." @default.
- W2890121022 created "2018-09-27" @default.
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- W2890121022 date "2018-09-14" @default.
- W2890121022 modified "2023-09-26" @default.
- W2890121022 title "Ilio‐inguinal‐transversus abdominis plane (I‐ TAP ) nerve block for elective caesarean section. A reply" @default.
- W2890121022 cites W2125019082 @default.
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- W2890121022 doi "https://doi.org/10.1111/anae.14439" @default.
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