Transversus abdominis plane block for abdominal surgery

Interest in techniques and applications of the transversus abdominis plane (TAP) block has expanded exponentially since its introduction over ten years ago. The choice of techniques and approaches has been assisted with the availability of ultrasound, but the optimal injection for certain surgical incisions are not yet clear. A literature search was performed looking at anatomical and distribution studies, and clinical trials evaluating the effects of TAP blocks in patients undergoing abdominal surgery. Case reports were also included. Clinical and contrast studies indicate that the landmark and ultrasound guided TAP blocks differ in their spread and mode of action. Regardless, both techniques provide effective analgesia for abdominal surgery. Further research is required to compare TAP blocks with epidural analgesia.

Stellate ganglion blockade for analgesia following upper limb surgery

We report the successful use of a stellate ganglion block as part of a multi-modal postoperative analgesic regimen. Four patients scheduled for orthopaedic surgery following upper limb trauma underwent blockade of the stellate ganglion pre-operatively under ultrasound guidance. Patients reported excellent postoperative analgesia, with postoperative VAS pain scores between 0 and 2, and consumption of morphine in the first 24 h ranging from 0 to 14 mg. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for stellate ganglion blockade to provide analgesia following major upper limb surgery.

Trunk blocks for abdominal surgery

In this review, we discuss the central non-neuraxial regional anaesthesia blocks of the abdomen, including intercostal and intrapleural blocks, rectus sheath and ilioinguinal-iliohypogastric blocks, transversus abdominis plane blocks and paravertebral blocks.