Bilateral transversus abdominus plane block for incisional hernia repairYavuz Gürkan1, Murat Tekin1, Ahmet Oktay Yirmibesoglu2, Emine Aysu Salviz3
1Departments Of Anesthesiology And Reanimation, Kocaeli University Faculty Of Medicine, Kocaeli
2Departments Of General Surgery, Kocaeli University Faculty Of Medicine, Kocaeli
3Department Of Anesthesiology And Reanimation, Sanliurfa Training And Research Hospital, Sanliurfa, Turkey
The transversus abdominus plane (TAP) block is a relatively new described regional anesthesia technique at the triangle of Petit, in order to block a number of abdominal wall nerves hence providing widespread analgesia. More recently, ultrasound guided TAP block has been described with promises of better localization and deposition of the local anaesthetic with improved accuracy. Its good postoperative analgesia effect has been shown several times in a variety of lower abdominal procedures;[3,4] however there has been controversy in the literature regarding the spread and level of block achieved with a single TAP injection.[5,6]Keywords: Transversus Abdominus Plane Block Ultrasound Incisional Hernia Repair
We would like to present a 62-year-old female, ASA physical status III patient with cirrhosis, cardiac failure, hypertension and diabetes mellitus, who underwent an incisional hernia repair. The patient had also undergone an umbilical hernia repair 2 months ago. Ultrasound guided TAP block was performed bilaterally as an anesthesia procedure. The block was performed using a high frequency linear probe (10-18 MHz, Esaote My Lab 30, Genoa, Italy). The block was performed at the mid-axillary line between the costal margin and iliac crest (Figure 1).
In plane technique was used and 20 mL of levobupivacaine 0.25% was applied for each side. For skin incision 5 mL of lidocaine 2% was used. In order to provide sedation and analgesia, 50 μcg of fentanyl and 1 mg of midazolam IV were administered. After depleting acid fluid and repairing 0.5 cm fascia defect, the operation was completed in 30 minutes uneventfully. Patient was comfortable during the surgery. The patient was followed for 5 days without any complication.
General anesthesia was not prefered in order to avoid cardiac and hepatic effects of systemic anesthetics. Although coagulation parameters seem to be normal, spinal anesthesia was not prefered because of low platelet counts (80 ×103/U).
This is the first case report presenting the use of TAP block for surgical anesthesia. TAP block could be considered as an anesthetic option for similar cases.
Yavuz Gürkan, Murat Tekin, Ahmet Oktay Yirmibesoglu, Emine Aysu Salviz. Bilateral transversus abdominus plane block for incisional hernia repair. Ağrı. 2011; 23(3): 134-135
Corresponding Author: Yavuz Gürkan, Türkiye