Modified TAP Block for Lower Abdominal Procedures

Luang Prabang, Laos - photo by JoAnn Sturman

Scott Sturman, M.D.

Conventional TAP blocks performed on obese patients can be tricky, owning to the depth of penetration and the steep needle trajectory.  The subcostal TAP on the other hand has the advantage of excellent needle visibility and well defined tissue planes.

Extend a parasagittal line downward from the nipple to the costal margin.  Use this intersection as the entry point for the modified TAP.  The needle is directed laterally and inferiorly until the TAP plane is identified.  Advance the needle as 30 cc of .25% bupivacaine is injected.  The local should form a prolated, football-like form as it separates the internal oblique and transverse abdominis. 

Nile at Cairo - photo by JoAnn Sturman