Name of the Procedure:

Transversus Abdominis Plane (TAP) Block (abdominal plane block, rectus sheath block) unilateral; by continuous infusion(s) (includes imaging guidance, when performed).

Summary

A Transversus Abdominis Plane (TAP) block is a regional anesthesia technique used to numb the abdominal area for surgery or pain relief. It involves injecting anesthetic medication into the abdominal wall near the nerves that supply sensation to the abdominal muscles. In this variant, continuous infusion is used to provide prolonged pain relief, and imaging guidance like ultrasound is employed to ensure accuracy.

Purpose

The TAP block is used to manage pain associated with abdominal surgeries, Post-Cesarean sections, or chronic abdominal pain conditions. The goal is to provide effective pain relief with minimal use of systemic painkillers, reducing opioid consumption and enhancing recovery.

Indications

• Patients undergoing abdominal surgeries, such as hernia repairs or C-sections.
• Individuals with chronic abdominal pain.
• Situations where post-operative pain management is necessary for better recovery.
• Patients who cannot tolerate systemic opioids due to allergies, side effects, or other contraindications.

Preparation

• Patients may need to fast for several hours prior to the procedure.
• Medications currently taken by the patient might need adjustment under a physician's guidance.
• Pre-procedure assessments may include physical examination, blood tests, and sometimes imaging studies.

Procedure Description

1. The patient is positioned comfortably, usually in a supine position.
2. An ultrasound or other imaging device is used to visualize the abdominal structures and to pinpoint the injection sites.
3. The skin is cleaned with an antiseptic solution to prevent infection.
4. Local anesthesia is given to numb the injection area.
5. A needle is inserted through the skin into the fascial plane between the transversus abdominis and the internal oblique muscles.
6. Once the correct location is confirmed, a catheter is placed for continuous infusion of anesthetic medication.
7. The catheter is secured, and a portable infusion pump may be connected to provide a steady flow of medication.

Duration

The initial procedure typically takes about 20-40 minutes to complete. Continuous infusion may last for several days, depending on the patient's needs.

Setting

The procedure is performed in a hospital, outpatient clinic, or surgical center, often in the operating room or a dedicated anesthesia room.

Personnel

• Anesthesiologist or pain specialist
• Nurse or anesthesia assistant
• Ultrasound technician (if imaging guidance is used)

Risks and Complications

• Infection at the catheter insertion site
• Bleeding or bruising
• Nerve damage (rare)
• Allergic reactions to the anesthetic
• Catheter displacement
• Inadequate pain relief requiring alternative methods

Benefits

• Effective pain relief reducing the need for systemic opioids
• Improved post-operative mobility and recovery
• Reduced side effects from oral pain medications

Recovery

• Patients may experience soreness at the catheter site.
• Follow physician's instructions on activity restrictions and catheter care.
• Regular follow-up appointments may be necessary to monitor pain control and catheter function.
• Full recovery from the procedure usually aligns with surgical recovery timelines.

Alternatives

• Oral or intravenous pain medications.
• Epidural anesthesia.
• Non-pharmacological pain management techniques like physical therapy.
• Each option carries different risk profiles and efficacy, often tailored to the individual patient's condition and needs.

Patient Experience

• Patients may feel mild discomfort during needle insertion but will not feel pain from the surgical area once the block takes effect.
• Continuous infusion provides ongoing pain relief, reducing the “peaks and valleys” of pain.
• Regular assessments by healthcare providers help manage any discomfort or complications.