A fascial plane block that provides effective long-lasting anesthesia for abdominal wall surgeries or post-operative surgical incision pain. Under direct ultrasound guidance using sterile technique, long-acting anesthetic is placed between the transversus abdominis and internal oblique muscles. Injection placed above and/or below the umbilicus depending on region of surgery and which quadrant needs to be anesthetized.
for the tap block um the space is pettit's triangle between the lower border the costal margin the anterior superior elac spine uh just about in the anterior axillary line is where the blocks going so we find those four muscles with the internal oblique being the biggest muscle go through the fascia go through the internal oblique through the fascia of the transversalis and then you're in the space between the transverse sounds and the internal abdominal oblique again we give a little test dose we see that anechoic spread of those two muscles and then the nurses change the syringe and we put 30 cc's per side of a mixture of x-barrel and saline so i'm starting between the costal margin and the anterior superioric spine and almost at the entire axillary line the further out i go really the better the block is going to be i'm going to put this through the skin and we're just going to follow the needle down and i can feel it go through the external abdominal bleed and um right on the internal i just felt it popped through the internal okay give a testos now i'm in the internal so i'm going to back up and go a little further okay test us again there we go okay switch over so that little bit of flash that you saw was in the internal and now i'm in the correct plane okay all right that's good feels good easy you can see the muscles just spreading yeah the fish mat yeah and there's the needle sitting right in that plane i'm wiggling it so you can see it on the video [Music] good and there's the image of see the internal oblique being split and then there's a transversal below and all the medications sitting there right between the muscles so that's exactly what we want to see and as you can see these blocks don't take very long they're simple to do and the patients really do appreciate the time and effort that we place uh in doing that you
