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Transversus Abdominis Plane Block

Section Editor(s): Saidman, LawrenceMcDonnell, John G. MB, FCARCSI; Laffey, John G. MD, MA, BSc, FCARCSI

doi: 10.1213/01.ane.0000268542.45107.79
Letters to the Editor: Letters & Announcements
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SDC

Department of Anaesthesia; Clinical Sciences Institute; Galway University Hospitals and National University of Ireland; Galway, Ireland; john.laffey@nuigalway.ie

We agree with Shibata et al. (1) regarding the utility of ultrasound for the performance of the transversus abdominis plane block and in fact have recently commenced clinical studies utilizing this technique. With regard to the spread of the block, we have demonstrated in volunteer studies that the transversus abdominis plane block continues to extend gradually as the local anesthetic spreads along the neural plane, with a maximal extent of the block evident only after several hours (2). This explains the contrast between the findings of Shibata et al. compared with those of ours, in that they only waited 30 min to assess the extent of the block. This also explains the reason the block needs to be performed at the beginning of the surgical procedure, and why opiates are given before skin incision. If performed in this manner, the block will have had sufficient time to extend up to T7, providing good postoperative analgesia in patients undergoing major abdominal surgery involving full length midline abdominal incisions, as demonstrated in our study (3).

John G. McDonnell, MB, FCARCSI

John G. Laffey, MD, MA, BSc, FCARCSI

Department of Anaesthesia

Clinical Sciences Institute

Galway University Hospitals and National University of Ireland

Galway, Ireland

john.laffey@nuigalway.ie

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REFERENCES

1. Shibata Y, Sato Y, Fujiwara Y, Komatsu T. Transversus abdominis plane block. Anesth Analg 2007;105:883
2. McDonnell JG, O' Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg 2007;104:193–7
3. McDonnell JG, O' Donnell BD, Tuite D, Farrell T, Power C. The regional abdominal field Infiltration (R.A.F.I.) technique: Computerised tomographic and anatomical identification of a novel approach to the transversus abdominis neuro-vascular fascial plane. Anesthesiology 2004;101: A899
© 2007 International Anesthesia Research Society