Friday, May 25, 2012

A field block for abdominal surgery

Field blocks are ways of delivering anesthesia to a region of the body via a strategically-placed injection. Say you're looking to numb up a fingertip laceration in order to suture it. Injecting lidocaine at the wound itself is not only excruciating, but can also distort the anatomy, since the lidocaine solution in itself takes up space. There's also the chance that you'll miss a spot. But you can numb the entire finger with a field block at its base (alas, not a painless injection). There are a number of field-block techniques out there--whether you're numbing up an ear, an ankle, an abscess, these techniques offer analgesia in a localized region of the body without requiring either wound injection or general anesthesia.

 An anesthesiologist recently told me about a field block for the abdominal wall. It's called a transversus abdominis plane block, or TAP block. Author Karim Mukhtar writes that the TAP block is "indicated for any lower abdominal surgery including appendectomy, hernia repair, caesarean section, abdominal hysterectomy and prostatectomy. Efficacy in laparoscopic surgery has also been demonstrated. Bilateral blocks can be given for midline incisions or laparoscopic surgery."

The TAP block would seem to be an awfully nice option for low-resource surgical practitioners. One can imagine the safety benefits in a setting where general anesthesia is impossible or risky. Mukhtar also describes an ultrasound-guided technique at the hyperlink above.

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