Liposomal Bupivacaine for Transversus abdominis plane block and laparoscopic technique
I'm a OB/GYN resident, we've been studying the effects of using liposomal bupivacaine for TAP block during robotic hysterectomy.
Background
Liposomal bupivacaine (Exparel) has been FDA approved for post-surgical analgesia since 2011. Its efficacy has been controversial when used as a transversus abdominis plane (TAP) block. Multiple established techniques include blind tap, ultrasound guided, and laparoscopic-assisted application.
Described Techniques of TAP block
- Blind “double pop” into Fascia of external oblique and internal oblique
- Ultrasound guided
- Laparoscopic assisted double pop (Chetwood A, et al. 2011)
We use the laparoscopic approach which doesn't require anesthesia involvement and is fast
Steps - Solution of 20mL of Exparel, 20mL of 0.25% Marcaine, 20mL of Saline
- Lateral border of rectus, subcostal margin and iliac crest demarcated
- Laparoscopic entry into the abdomen
- Triangle of Petit is identified, point of entry is confirmed visually and marked
- Exparel injected using Veress needle by feeling the “double pop”
- Confirmed visually by the presence of Doyle’s bulge, as the transversus abdominis muscle and peritoneum is tented up
Here's a video for demonstration
Hi, @raincepted
I'm a Korean surgeon. It's nice to find a post of medicine on Steemit. I plan to post a lot of articles in English / Korean(you can use google translation). I hope we can communicate often. Happy new year :)
oh hi, great to meet you. I would love to exchange ideas and stuff. happy new year to you!