Name of the Procedure:

Transversus Abdominis Plane (TAP) Block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)

Summary

The Transversus Abdominis Plane (TAP) block is a regional anesthesia technique used to numb the abdominal area. It involves injecting local anesthetic into the space between the muscles of the abdominal wall, often using imaging guidance to ensure precise placement. This procedure helps to manage pain after abdominal surgeries.

Purpose

This procedure is designed to provide pain relief following abdominal surgeries such as hernia repair, cesarean sections, or other procedures involving the abdominal area. The goal is to reduce pain, minimize the need for opioid pain medications, and enhance recovery.

Indications

• Postoperative pain from abdominal surgeries
• Chronic abdominal pain conditions
• Patients who are sensitive to opioid pain medications or prefer to minimize opioid use

Preparation

• Patients may need to fast for a certain period before the procedure (typically 6-8 hours).
• Review of current medications, with possible adjustments, especially blood thinners.
• Pre-procedure imaging or assessments to evaluate the abdominal area and plan the injection site(s).

Procedure Description

1. The patient is positioned comfortably, typically lying on their back.
2. The skin over the abdominal area is cleaned and sterilized.
3. Local anesthesia is administered to numb the skin and underlying tissues where the needle will be inserted.
4. Using imaging guidance (ultrasound), the healthcare provider locates the transversus abdominis plane.
5. A needle is inserted into the plane, and local anesthetic is injected on both sides of the abdomen.
6. The injection may be repeated in different spots to ensure adequate coverage.

Duration

The procedure typically takes about 30-45 minutes.

Setting

The TAP block is usually performed in a hospital, outpatient clinic, or surgical center.

Personnel

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

Risks and Complications

• Common risks include bleeding, infection at the injection site, and temporary numbness or weakness.
• Rare complications may include injury to nearby organs or blood vessels, allergic reactions to anesthetics, and persistent numbness or pain.
• Complications are managed based on the individual patient's condition and severity.

Benefits

• Significant reduction in postoperative pain.
• Decreased need for opioid pain medications.
• Faster recovery and improved ability to participate in postoperative rehabilitation.

Recovery

• Patients are typically monitored for a short period after the procedure to ensure there are no immediate complications.
• Normal activities can usually be resumed within a day, although strenuous activities should be avoided for a few days.
• Follow-up appointments may be scheduled to assess pain control and recovery progress.

Alternatives

• Systemic pain medications (e.g., oral or IV opioids)
• Epidural anesthesia
• Other nerve block techniques
• Pros: TAP block provides targeted pain relief with fewer systemic effects.
• Cons: TAP block is a more technical procedure requiring imaging and may not be suitable for everyone.

Patient Experience

• During the procedure, patients might feel pressure or mild discomfort from the needle insertion and local anesthetic injection.
• After the procedure, patients typically have reduced pain in the abdominal area.
• Pain management options such as oral analgesics may be provided for additional comfort.
• It is important to follow all postoperative instructions to ensure the best outcomes and minimize complications.