How to Perform a Tap Block with Ultrasound

Objective

Learn how to perform a Tap block to provide post operative analgesia for patients undergoing abdominal surgery. Tap blocks can be easily performed with any Sonosite ultrasound system.

Procedure Description:

• Begin by placing the ultrasound transducer subcostal at the anterior axillary line.
• The external oblique, internal oblique and transversus abdominis muscles should be identified.
• Use the in-plane needle technique with a medial to lateral approach. Local anaesthetic is deposited superficial to the transversus abdominis muscle and deep to the fascia located superficial to the muscle.

Image

Patient Positioning:

Supine

Transducer:

L12-3, L15-4

Technique:

• The TAP block is a fascial plane block. Like most fascial plane blocks the success of the block is volume dependent.
• The TAP block provides only somatic analgesia to the anterior abdominal wall. It does not provide visceral analgesia.
• A more lateral/posterior injection of local anaesthetic will allow for coverage of the lower abdomen for example the pfannenstiel incision for C-sections. A medial/anterior injection will provide better coverage of the mid/upper abdomen.

Teaching Points: 

• The Tap Block performed at the costal border of the abdomen will ensure optimal coverage of the abdominal wall.
• T7 coverage is not reliable from a TAP block. TAP blocks may be combined with rectus sheath blocks for optimal coverage of the abdominal wall.
• See How To Video: Ultrasound Guided TAP Block