title: Ultrasound-guided bilateral dual transversus abdominis plane block: a new four-point approach.
abstract: BACKGROUND
  We describe a new ultrasound-guided bilateral dual transversus abdominis plane block. Our hypothesis was that we could anaesthetize both the upper (Th6-Th9) and the lower (Th10-Th12) abdominal wall bilaterally using a four-point single-shot technique to provide effective post-operative analgesia.
  
  
  METHODS
  A prospective cohort of 25 recovery room patients was included. They had undergone major open or laparoscopic abdominal surgery under general anaesthesia and had severe post-operative pain. The blocks were conducted using a high-frequency linear transducer and a 22 G, 80-mm-long needle. The needle was inserted in-plane from medial to lateral for each injection. Fifteen millilitres of bupivacaine 2.5 mg/ml was injected at each of the four sites.
  
  
  RESULTS
  Block performance took on average 16 min (range 10-20 min). The 25 patients reported a reduction of their maximum pain (visual analogue scale 0-10) from a mean of 8.2 to a mean of 2.2 10 min after block performance (P<0.001). They were discharged from the post-anaesthesia care unit after an average of 34 min. Twenty-one patients (84%) did not require any i.v. opioids in the following 6 h. Sixteen patients (64%) were mobilized within 6 h after the block. Data were similar irrespective of open or laparoscopic surgery (P=0.68).
  
  
  CONCLUSIONS
  This new four-point single-shot technique was effective in decreasing severe pain after a major abdominal surgery. The block, although short-lived, facilitated discharge from the post-anaesthesia care unit, few patients required opioids on the day of surgery and mobilization was improved.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Denmark. jbn@dadlnet.dk
authors.forename: J
authors.initials: J
authors.lastname: Børglum
authors.forename: C
authors.initials: C
authors.lastname: Maschmann
authors.forename: B
authors.initials: B
authors.lastname: Belhage
authors.forename: K
authors.initials: K
authors.lastname: Jensen
mesh_terms: D000005:Abdomen / Q000601:surgery*; D034861:Abdominal Wall / Q000000981:diagnostic imaging / Q000294:innervation*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000628:therapy*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*