The TAP block is really just another version of the old style iliohypogastric ilioinguinal nerve block performed blindly by locating the ASIC and moving medially and cranially 2 cm each. After two pops, and injection is made. However, the blind technique has a higher failure rate than newer technques utilizing US. Placing the probe as depicted below, just above the iliac crest, the external and internal abdominal oblique muscles will become apparent. Just below these two, the third muscle layer of the abdominal wall, is the transversus abdominus muscle. An injection of LA (I use 30 mL) will separate the TA plane. You should look for the TA muscle to press down into the peritoneum. After placing the LA, inserting a catheter for continuous infusion is quite simple if you choose to do this.
I placed a TAP block in the patient under GETA at the end of the case. In recovery he did not experience any pain at all from the graft site.
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