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
Transducer position: transverse on the abdomen, at the anterior axillary line, between the costal margin and the     iliac crest
Goal: local anesthetic spread between the transversus abdominis and internal oblique muscle planes
Local anesthetic: 20 – 30 mL of 0.25% ropivacaine per side (adults)
B – ILIOHYPOGASTRIC AND ILIOINGUINAL NERVE
Indications: anesthesia and postoperative analgesia for inguinal hernia repair and other inguinal surgery; analgesia     following suprapubic incision
Transducer position: oblique on abdomen, on a line joining the anterior superior iliac spine (ASIS) with the     umbilicus
Goal: local anesthetic spread between the transversus abdominis and internal oblique muscle planes, in the     vicinity of the two nerves
Local anesthetic: 10 mL per side (adults); 0.15 mL/kg per side (children)
C – RECTUS SHEATH
Indications: postoperative analgesia for umbilical hernia repair and other umbilical surgery
Transducer position: transverse on abdomen, immediately lateral to umbilicus
Goal: local anesthetic spread between rectus muscle and posterior rectus sheath
Local anesthetic: 10 mL per side (adults); 0.1 mL/kg per side (children)
D – LATERAL FEMORAL CUTANEOUS NERVE
Indications: postoperative analgesia for hip surgery,meralgia paresthetica, and muscle biopsy of the proximal     lateral thigh
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)
Goal: Local anesthetic spread between the tensor fascia latae (TFL) and the sartorius muscle
Local anesthetic: 5-10 mL (adults)

PART 1: TRANSVERSUS ABDOMINIS PLANE BLOCK (TAP)