Can ultrasound-guided subcostal transverse abdominis plane block be used as sole anesthetic technique?

Abstract

Subcostal transverse abdominis plane (TAP) block anesthetizes area of the abdomen with cutaneous innervation of T6–T10 dermatomes. These abdominal field blocks become very advantageous when cardiac patient presents for noncardiac surgeries as sole anesthetic or as a part of multimodal anesthesia. A 58-year-male came for open surgical repair of subxiphoid incisional hernia developed post coronary artery bypass grafting (CABG). Echocardiography showed hypokinesia of left ventricle (LV) in the left anterior descending (LAD) artery territory, dilated LV, and ejection fraction of 30%, and coronary angiography after 6 months of CABG showed 70% stenosis of LAD. Surgery was successfully accomplished under ultrasound-guided bilateral subcostal TAP block except for a brief period of pain and discomfort when hernia was being reduced which required narcotic supplementation. The patient remained comfortable throughout the procedure as well as 24 h postoperatively without any analgesic supplementation. Thus, subcostal TAP block can be a safe alternative to neuraxial or general anesthesia for epigastric hernia repair in selected patients.

Ultrasound-guided bilateral subcostal TAP block for epigastric hernia repair: A case series

“…[4] A case of large incisional epigastric hernia repair in a high-risk cardiac patient (ASA III), which was operated under bilateral subcostal TAP block, was reported by Bihani et al . [9]…”

“…Although all the study patients were ASA physical status I or II, subcostal TAP block may be particularly advantageous in ASA 3 and 4 by reducing the opioids' requirements. [9] Inability to block visceral component of pain is also a disadvantage of TAP block.…”

Transversus abdominis plane block as a sole anesthetic technique for evacuation of rectus abdominis muscle hematoma - A case report -

“…However, only a few cases of the use of a TAP block as the sole anesthetic technique have been reported. Recently, TAP blocks have been used as the sole anesthetic technique in inguinal hernia repair [ 5 , 10 ], open gastrostomy [ 3 ], colectomy [ 4 ], ileostomy [ 4 ], wedge resection of cecal cancer [ 4 ], and abdominal wall abscess incision and drainage [ 11 ]. In particular, the last abdominal surgery mentioned above was similar to the present study in the type of surgery and location of the lesion.…”

“…Although there are some differences in the literature, the analgesic effect of TAP blocks is generally found in the T6-L1 dermatomes of the anterolateral abdominal wall [ 1 , 5 , 8 , 12 ]. However, a cadaveric study by Tran et al [ 13 ] demonstrated that TAP blocks most effectively blocked the dermatomes of T11-L1 and only 50% of the T10.…”

“…However, only a few case reports have documented the use of a TAP block alone as a surgical anesthesia, and the anesthetic role of TAP blocks has not yet been clearly defined [ 3 ]. According to such case reports, TAP blocks have been adopted as the sole anesthetic technique for high-risk patients who are elderly, have severe systemic diseases, or have contraindications for other methods of anesthesia [ 2 , 4 , 5 ]. This case report differs from the previous case reports in that the TAP block was performed on a nursing primipara woman who refused other anesthesia techniques.…”