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Injection of local anaesthetic via a catheter inserted into the epidural space
Unilateral block of the spinal nerve including the dorsal and ventral rami
Preferentially acts on afferent sensory receptors
E.g. In labour the female may not feel pain but will feel the pressure
However, an epidural will block other types of nerve fibers in a dose dependent manner
Unilateral or bilateral anaesthsia or analgesia
Patients where hypotension or sympathetic blockade from epidural would be particuarly detrimental
Paravertebral block is preferbale to epidural in patients with coagulopathy
The Bromage Score for motor blockade
Tummala, et al (2015). A comparative study-efficacy and safety of combined spinal epidural anesthesia versus spinal anesthesia in high-risk geriatric patients for surgeries around the hip joint
Salaman, et al (2012). Combined Spinal-Epidural Anesthesia with Epidural
Volume Extension causes a Higher Level of Block than Single-Shot Spinal Anesthesia
Zhang et al, 2014. Single-Dose, Bilateral Paravertebral Block Plus Intravenous Sufentanil Analgesia in Patients With Esophageal Cancer Undergoing Combined Thoracoscopic– Laparoscopic Esophagectomy: A Safe and Effective Alternative
Peripheral nerve block designed to anaethetise the nerves supplying the anterior abdominal wall (T6-L1)
Injection of local anaesthetic into the deep fascial plane between the internal oblique and the transversus abdominus
Used as an adjunct for post operative pain control
Surgery in the T6 - L1 distribution
Blind landmark technique OR ultrasound guided technique
Sinah et al. 2013; The efficacy of ultrasound-guided transversus abdominis plane block after laparoscopic bariatric surgery
Calle et al. 2014; Transversus abdominus plane block after ambulatory total laprascopic hysterectomy: Randomized controlled trial
IF TAP BLOCK WORKS
IF TAP BLOCK DOES NOT WORK
Ineffective pain management
Effective pain management
= Greater compliance with PT Rx
Pt less likely to mobilise, cough, exercise secondary to high pain levels
Greater opioid use for pain management
Decreased need for opioids
= less nausea, respiratory depression, drowsiness
Better outcomes for your patient
The pt will either have little/no pain OR have high levels of pain
Total numbness of the spinal levels above and below the injection sight
Lower abdomen and below;
May be used in conjuction with a general anaesthetic, or in isolation.
Useful for patients with severe respiratory distress e.g. COPD
Local anaesthetic injected through the dura into the cerebrospinal fluid
Barash, P. G., Cullen, B. F., Stoelting, R. K., Calahan, M. K., Stock, C. M. (2009). Clinical Anesthesia (6th ed.). Philadelphia, PA. Wolters Kluwer
(https://en.wikipedia.org/wiki/Spinal_anaesthesia)
Retrieved on; 13.08.2015
Military Advanced Regional Anesthesia and Analgesia. (2008). The Military Advanced Regional Anesthesia and Analgesia Handbook. Retrieved on 16.08.2015, Retrieved from; http://www.dvcipm.org/clinical-resources/dvcipm-maraa-book-project
Byram, S. W. (2013). Medscape: Nerve Block. retreieved on 16.08.2015. retrieved from; http://emedicine.medscape.com/article/2000541-overview#a3
(https://en.wikipedia.org/wiki Epidural_administration)
Retrieved on; 13.08.2015
Chawla, J., (2013). Medscape: Epidural Nerve Block. Retrieved 14.08.2015, retrieved from; http://emedicine.medscape.com/article/149646-overview#a9
Calle, G. A., López, C. C., Sánchez, E., Los Ríos, J. F., Vásquez, E. M., Serna, E., ... & Almanza, L. A. (2014). Transversus abdominis plane block after ambulatory total laparoscopic hysterectomy: randomized controlled trial. Acta obstetricia et gynecologica Scandinavica, 93(4), 345-350.
(http://www.pitt.edu/~regional/Epidural/epidural.html)
Retrieved on 13.08.2015
Mukhtar, K. (2009). Transversus abdominis plane (TAP) block. The Journal of New York School of Regional Anesthesia, 12, 28-33.
(http://bonesmart.org/forum/threads/anaesthetics-spinals-femoral-blocks-gas-and-everything-else.5579/).
Retrieved on 15.08.2015
Liou, L. S., (2013). Medline Plus: Spinal and Epidural anesthesia. Retrieved 14.08.2015. retrieved from; http://www.nlm.nih.gov/medlineplus/ency/article/007413.htm
Salman, C., Kayacan, N., Ertuğrul, F., Bıgat, Z., & Karslı, B. (2013). Combined spinal-epidural anesthesia with epidural volume extension causes a higher level of block than single-shot spinal anesthesia. Revista Brasileira de Anestesiologia, 63(3), 267-272.
(http://www.google.com/search?client=safari&rls=en&q=factors+affecting+distribution+of+spinal+anaesthesia&oe=UTF-8&gfe_rd=cr&hl=en&sa=X&as_q=&spell=1&ved=0CBEQvwVqFQoTCNqa1qD_rMcCFQgZpgodqBcA2Q)
Retrieved on 14.08.2015
Tighte. S, M. (2010). Continuing care in anaesthesia, critical care and pain: Paravertebral block. Retrieved 16.08.2015, retrieved from; http://ceaccp.oxfordjournals.org/content/10/5/133.full
Sinha, A., Jayaraman, L., & Punhani, D. (2013). Efficacy of ultrasound-guided transversus abdominis plane block after laparoscopic bariatric surgery: a double blind, randomized, controlled study. Obesity surgery, 23(4), 548-553.
Tummala, V., Rao, L. N., Vallury, M. K., & Sanapala, A. (2015). A comparative study-efficacy and safety of combined spinal epidural anesthesia versus spinal anesthesia in high-risk geriatric patients for surgeries around the hip joint. Anesthesia: Essays and Researches, 9(2), 185.
Wisanen, M. T., (2013). Medscape: Transversus Abdominus Plane Block. Retrieved 14.08.2015, retrieved from; http://emedicine.medscape.com/article/2000944-overview
( http://www.nysora.com/techniques/neuraxial-and-perineuraxial-techniques/landmark-based/3077-thoracic-paravertebral-block.html). Retrieved on 16.08.2015
Zhang, W., Fang, C., Li, J., Geng, Q. T., Wang, S., Kang, F., ... & Wei, X. (2014). Single-Dose, Bilateral Paravertebral Block Plus Intravenous Sufentanil Analgesia in Patients With Esophageal Cancer Undergoing Combined Thoracoscopic–Laparoscopic Esophagectomy: A Safe and Effective Alternative. Journal of cardiothoracic and vascular anesthesia, 28(4), 978-984.