title: Spread of injectate after ultrasound-guided subcostal transversus abdominis plane block: a cadaveric study.
abstract: Ultrasound-guided transversus abdominis plane (TAP) block can be performed using a subcostal technique. This technique was simulated using dye injection in cadavers in order to determine segmental nerve involvement and spread of injectate using either single or multiple-injection techniques. Dye most commonly spread to affect T9 and T10 nerves with the single injection technique and T9, T10 and T11 with multiple injections. The median (IQR [range]) spread of dye was 60 (36-63 [32-78]) cm(2) using the single-injection technique and 90 (85-96 [72-136]) cm(2), in the multiple-injection technique, and this difference was statistically significant (p = 0.003). These results indicate that ultrasound-guided subcostal TAP block will involve nerve roots T9, T10 and T11 and that a multiple-injection technique may block more segmental nerves and increase spread of injectate.
authors.affiliation: Department of Anaesthesia, St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia. michael.barrington@svhm.org.au
authors.forename: M J
authors.initials: MJ
authors.lastname: Barrington
authors.forename: J J
authors.initials: JJ
authors.lastname: Ivanusic
authors.forename: W M
authors.initials: WM
authors.lastname: Rozen
authors.forename: P
authors.initials: P
authors.lastname: Hebbard
mesh_terms: D000009:Abdominal Muscles / Q000000981:diagnostic imaging / Q000294:innervation / Q000378:metabolism; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004396:Coloring Agents / Q000008:administration & dosage / Q000493:pharmacokinetics; D004334:Drug Administration Schedule; D006801:Humans; D009407:Nerve Block / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000779:Anesthetics, Local; D004396:Coloring Agents