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Truncal and Cutaneous Blocks – Recent Advances in USG GUided Techinique

Figure 1: (A) Transducer position and needle insertion to accomplish a transverse abdominal plane block. (B) Transducer position and needle insertion to accomplish iliohypogastric and ilioinguinal nerve blocks. (C) Transducer position and needle insertion to accomplish rectus sheath block. (D) Transducer position and needle insertion to accomplish a lateral femoral cutaneous nerve (LFCN) block.
Essentials
A – TRANSVERSUS ABDOMINIS PLANE (TAP)

Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 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 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 Goal: local anesthetic spread between the transversus abdominis and internal oblique muscle planes
Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 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 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 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 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 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 Indications: postoperative analgesia for umbilical hernia repair and other umbilical surgery
Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique Transducer position: transverse on abdomen, immediately lateral to umbilicus
Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique Goal: local anesthetic spread between rectus muscle and posterior rectus sheath
Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique 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 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 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 Goal: Local anesthetic spread between the tensor fascia latae (TFL) and the sartorius muscle
Truncal and Cutaneous Blocks - Recent Advances in USG GUided Techinique Local anesthetic: 5-10 mL (adults)
PART 1: TRANSVERSUS ABDOMINIS PLANE BLOCK (TAP)

 
 
Source  and detail of procedure is given at : http://www.nysora.com/techniques/ultrasound-guided-techniques/3253-truncal-and-cutaneous-blocks.html
 

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