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Reply to: transversus abdominis plane block in inguinal hernia repair

Petersen, Pernille L.; Mathiesen, Ole; Dahl, Joergen B.

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European Journal of Anaesthesiology: July 2014 - Volume 31 - Issue 7 - p 392
doi: 10.1097/EJA.0000000000000075
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We thank Dr Børglum et al.1 for their interest in our study of transversus abdominis plane (TAP) block in inguinal hernia repair. Their letter pinpoints the difficultly in evaluating the effect of the TAP block, because there are different types of TAP blocks and there is no consensus of the nomenclature.

The TAP block that was used in our study was performed with the ultrasound probe in the mid-axillary line between the iliac crest and the costal margin with the injection point anterior to the ultrasound probe.2 We call this a posterior TAP block according to Peter Hebbard, who was the first to describe this ultrasound-guided TAP block.3 This type of block is also called mid-axillary, classic or lateral TAP block and the TAP block applied via the triangle of Petit has been called posterior TAP block by some authors.

We agree with Dr Børglum et al. that the TAP block applied via the triangle of Petit and the more recently used ultrasound-guided TAP blocks that are applied more anteriorly, are two different blocks. Local anaesthetics applied via the triangle of Petit have a more distant spread via the paravertebral space. A recent review has demonstrated that the duration of analgesic efficacy of the TAP block applied via the triangle of Petit is longer than the ultrasound-guided TAP block.4

Acknowledgements relating to this article

Assistance with the letter: none.

Financial support and sponsorship: none.

Conflicts of interest: none.


1. Børglum J, Tanggaard K, Moriggl B, McDonnell JG. Transversus abdominis plane block in inguinal hernia repair. Eur J Anaesthesiol 2014; 31:391–392.
2. Petersen PL, Mathiesen O, Stjernholm P, et al. The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal hernia repair. A randomised clinical trial. Eur J Anaesthesiol 2013; 30:415–421.
3. Lee TH, Barrington MJ, Tran TM, et al. Comparison of extent of sensory block following posterior and subcostal approaches to ultrasound-guided transversus abdominis plane block. Anaesth Intensive Care 2010; 38:452–460.
4. Abdallah FW, Laffey JG, Halpern SH, Brull R. Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: a meta-analysis. Br J Anaesth 2013; 111:721–735.
© 2014 European Society of Anaesthesiology