Name of the Procedure:

Transversus Abdominis Plane (TAP) Block (Abdominal Plane Block, Rectus Sheath Block) — Bilateral; by Continuous Infusions (includes imaging guidance, when performed)

Summary

A Transversus Abdominis Plane (TAP) block is a pain management procedure designed to numb the abdominal muscles and tissues. This involves the continuous infusion of an anesthetic near the nerves in the abdominal wall on both sides of the body, often with the help of imaging techniques to guide the placement.

Purpose

The TAP block is primarily used for pain relief following abdominal surgeries, such as C-sections or hernia repairs. The goal is to provide effective pain control, reduce the need for systemic opioids, and enhance the patient's comfort during the post-operative recovery period.

Indications

• Moderate to severe post-operative pain after abdominal surgery
• Pain that is not adequately controlled by oral or systemic analgesics
• Patients with a contraindication to systemic opioids

Preparation

• Patients may need to fast for several hours before the procedure.
• Medications, such as blood thinners, may need to be adjusted or paused.
• A full medical history and physical examination are typically required.
• Pre-procedure imaging studies, such as an ultrasound, may be conducted.

Procedure Description

1. The patient is positioned comfortably, usually lying on their back.
2. The area where the block will be performed is cleaned and sterilized.
3. Local anesthetic may be administered at the insertion site to numb the skin.
4. Using ultrasound or other imaging guidance, a needle is carefully inserted into the transversus abdominis plane.
5. A catheter is threaded through the needle for continuous infusion of the anesthetic.
6. The catheter is secured, and an infusion pump is set to deliver a constant flow of anesthetic.
7. The same steps are repeated on the opposite side of the abdomen.

Duration

The initial placement of the TAP block typically takes about 30-60 minutes. The duration of the anesthetic infusion can vary, often continuing for 24 to 72 hours.

Setting

The procedure is usually performed in a hospital, either in the surgical suite or a specialized pain management unit.

Personnel

• Anesthesiologist or pain management specialist
• Surgeon (if part of surgical pain management plan)
• Nurses and possibly ultrasound technicians

Risks and Complications

• Infection at the catheter insertion site
• Bleeding or hematoma formation
• Nerve damage
• Inadequate pain control
• Allergic reaction to the anesthetic
• Local anesthetic systemic toxicity (if anesthetic enters bloodstream)

Benefits

• Effective localized pain relief
• Reduced need for systemic opioids and their associated side effects
• Improved postoperative comfort and mobility
• Possible faster recovery and discharge time

Recovery

• Patients are monitored for any immediate side effects of the procedure.
• Typically, normal activities can be resumed gradually, as tolerated.
• Follow-up appointments may be scheduled to assess pain control and remove the infusion catheter if still in place.

Alternatives

• Systemic opioid or non-opioid analgesics
• Epidural anesthesia
• Other regional nerve blocks
• Non-pharmacological pain management strategies (e.g., physical therapy, relaxation techniques)

Patient Experience

During the procedure, patients may feel pressure or mild discomfort at the insertion sites. Post-procedure, patients commonly experience significant relief from abdominal pain. Continuous infusions provide ongoing numbing, and any discomfort or pain experienced can usually be managed effectively with additional medications or interventions as needed.