Ultrasound-guided transversus abdominis plane block for spinal infusion and neurostimulation implantation in two patients with chronic pain.
OBJECTIVE
This case report describes an ultrasound approach to the transversus abdominis plane (TAP) local anesthetic block. This block induces sensory blockade in the lower half of the abdomen where the pulse generator or the infusion pump is to be housed in a subcutaneous pocket, and therefore provides an alternate to general anesthesia or administration of high-dose local anesthetics.


METHODS
We report two cases of neuromodulation procedures-implantation of an internal morphine pump for severe somatic pain refractory to other therapies and placement of a double-stimulator generator for dorsal column stimulation in a patient diagnosed with postoperative failed-back syndrome. We successfully used ultrasound-guided TAP block to achieve ipsilateral sensory block of dermatomes T9-L1 in the context of a monitored anesthesia care multimodal approach.


CONCLUSIONS
TAP block can be a potentially useful substitute to general anesthesia or local anesthesia for the pocket formation in neuromodulation techniques, and it provides adequate anesthesia of the abdominal wall. This block is potentially an important addition to the monitored anesthesia care protocol.
Asensio-Samper
J M
JM
Anesthesia, Critical Care and Multidisciplinary Unit for Pain Management, Valencia University General Hospital, 46014 Valencia, Spain. jmasensiosamper@hotmail.com
De Andrés-Ibáñez
J
J
Fabregat Cid
G
G
Villanueva Pérez
V
V
Alarcón
López
L
D000005:Abdomen / Q000000981:diagnostic imaging* / Q000601:surgery; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000000981:diagnostic imaging*; D059408:Pain Management; D010147:Pain Measurement; D018084:Ultrasonography, Interventional / Q000379:methods*
D000779:Anesthetics, Local