Transversus Abdominis Plane Block

To the Editor:

Using a “double-pop” technique to advance a needle into the transversus abdominis neurofascial plane via the lumbar triangle of Petit, McDonnell et al. (¹) reported excellent analgesia following transversus abdominis plane (TAP) block. Following the earlier report of the results of this technique from these authors (²), we have performed transversus abdominal plane block under ultrasound guidance in patients undergoing gynecological abdominal surgery. The transversus abdominis neurofascial plane can be easily visualized on the midaxillary line and the local anesthetic spread can be confirmed in real-time.

We disagree with McDonnell et al. that TAP block can produce a dermatomal sensory block of the lower six thoracic and upper lumbar abdominal afferents. We assessed the extent of ultrasound guided TAP block by pinprick in 26 patients undergoing laparoscopic gynecological surgery. The mean upper and level of sensory block at 30 min after local anesthetic injection were T10 (range, T9–11), L1 (range, T12–L1), respectively. We think that lower abdominal surgery should be an indication for TAP block.

Yasuyuki Shibata, MD

Yuko Sato, MD

Yoshihiro Fujiwara, MD, PhD

Toru Komatsu, MD, PhD

Department of Anesthesiology

Aichi Medical University School of Medicine

Aichi, Japan

[email protected]