Anesthetic techniques: focus on transversus abdominis plane (TAP) blocks

Figures & data

Figure 1 Triangle of Petit.

Figure 2 Suggested ultrasound probe positions for various approaches. (A) Initial scanning position for identification of linea alba and rectus abdominis, (B) probe position for subcostal approach, (C) probe position for lateral approach, (D) probe position for posterior approach.

Figure 3 USG image at position 1 of Figure 2.

Abbreviations: RA, rectus abdominis; LA, linea alba; USG, ultrasound guided.

Figure 4 Subcostal TAP block. Arrow highlights the tap plane where the drug should be deposited.

Abbreviations: RA, rectus abdominis; IO, internal oblique; EO, external oblique; LS, linea semilunaris; SC, subcutaneous tissue; P, peritoneum; TAP, transverse abdominis plane.

Figure 5 Subcostal TAP block: direction of needle and probe.

Abbreviation: TAP, transverse abdominis plane.

Figure 6 Lateral TAP block. Direction of needle and probe.

Abbreviation: TAP, transverse abdominis plane.

Figure 7 Lateral TAP block. Arrow highlights the tap plane where drug should be deposited.

Abbreviations: RA, rectus abdominis; IO, internal oblique; EO, external oblique; SC, subcutaneous tissue; P, peritoneum; TAP, transverse abdominis plane.

Figure 8 Posterior TAP block. Direction of needle and probe.

Abbreviation: TAP, transverse abdominis plane.

Figure 9 Posterior TAP block. Arrow highlights the TAP plane where drug should be deposited.

Abbreviations: RA, rectus abdominis; IO, internal oblique; EO, external oblique; SC, subcutaneous tissue; P, peritoneum; QL, quadratus lumborum; TAP, transverse abdominis plane.

Table 1 Classification of USG guided TAP block

Approach	Nerves blocked	Supplied areas
Subcostal	T6–T9 – Anterior cutaneous nerves	Upper abdomen, just below xiphoid and parallel to costal margin
Lateral	T10–T12 – Anterior cutaneous nerves	Anterior abdominal wall at the infraumbilical area, between two midclavicular lines
Posterior	T9–T12 – Anterior and possibly lateral cutaneous nerves	Anterior abdominal wall at the infraumbilical area and possibly lateral abdominal wall
Oblique subcostal	T6–L1 – Anterior cutaneous nerves	Supraumbilical and infraumbilical anterior abdominal wall
Dual TAP	T6–T12 – Anterior and possibly lateral cutaneous nerves	Supraumbilical and infraumbilical anterior abdominal wall

Notes: Adapted from Tsai HC, Yoshida T, Chuang TY, et al. Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int. 2017;2017:8284363.⁷ Copyright © 2017 Hsiao-Chien Tsai et al.

Abbreviations: TAP, transverse abdominis plane; USG, ultrasound guided.

Figure 10 Direction of hydrodisscetion in oblique subcostal block. Initially subcostal TAP block is performed, then the needle moved along the oblique subcostal line.

Abbreviation: TAP, transverse abdominis plane.

Tsai H-C, Yoshida T, Chuang T-Y, et al. Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int. 2017;2017(8284363). doi:10.1155/2017/8284363

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