![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Indications: postoperative analgesia for laparotomy, appendectomy, laparoscopic surgery, abdominoplasty, and cesarean delivery; as an alternative to epidural anesthesia for operations on the abdominal wall
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Transducer position: transverse on the abdomen, at the anterior axillary line, between the costal margin and the iliac crest
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Goal: local anesthetic spread between the transversus abdominis and internal oblique muscle planes
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Local anesthetic: 20 – 30 mL of 0.25% ropivacaine per side (adults)
B – ILIOHYPOGASTRIC AND ILIOINGUINAL NERVE
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Indications: anesthesia and postoperative analgesia for inguinal hernia repair and other inguinal surgery; analgesia following suprapubic incision
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Transducer position: oblique on abdomen, on a line joining the anterior superior iliac spine (ASIS) with the umbilicus
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Goal: local anesthetic spread between the transversus abdominis and internal oblique muscle planes, in the vicinity of the two nerves
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Local anesthetic: 10 mL per side (adults); 0.15 mL/kg per side (children)
C – RECTUS SHEATH
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Indications: postoperative analgesia for umbilical hernia repair and other umbilical surgery
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Transducer position: transverse on abdomen, immediately lateral to umbilicus
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Goal: local anesthetic spread between rectus muscle and posterior rectus sheath
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Local anesthetic: 10 mL per side (adults); 0.1 mL/kg per side (children)
D – LATERAL FEMORAL CUTANEOUS NERVE
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Indications: postoperative analgesia for hip surgery,meralgia paresthetica, and muscle biopsy of the proximal lateral thigh
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Transducer position: transverse, immediately inferior to the anterior superior iliac spine (ASIS); the lateral edge of sartorius (SaM) muscle should be visualized with ultrasound (US)
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Goal: Local anesthetic spread between the tensor fascia latae (TFL) and the sartorius muscle
![Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 1 Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxMCIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDEwIDEwIj48cmVjdCB3aWR0aD0iMTAwJSIgaGVpZ2h0PSIxMDAlIiBzdHlsZT0iZmlsbDojY2ZkNGRiO2ZpbGwtb3BhY2l0eTogMC4xOyIvPjwvc3ZnPg==)
Local anesthetic: 5-10 mL (adults)