• Christopher Blom Salmonsen, LangeKai Henrik WiborgKHWDepartment of Anesthesiology, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Christian Rothe, Jakob Kleif, and Claus Anders Bertelsen.
• Department of Surgery, Copenhagen University Hospital - North Zealand, Hillerod, Denmark christopher.blom.salmonsen@regionh.dk.
• Reg Anesth Pain Med. 2024 Apr 2; 49 (4): 289292289-292.

Background And ObjectivesThe transversus abdominis plane block (TAP) can be applied using different approaches, resulting in varying cutaneous analgesic distributions. This study aimed to assess the cutaneous sensory block area (CSBA) after ultrasound-guided TAP (US-TAP) using the subcostal approach.MethodsThirty patients undergoing elective laparoscopic cholecystectomy received a subcostal US-TAP with 20 mL 2.5 mg/mL ropivacaine bilaterally. Measurements were performed 150 min after block application. The CSBA was mapped using cold sensation and a sterile marker, photodocumented, and transferred to a transparency. The area of the CSBA was calculated from the transparencies.ResultsThe median CSBA of the subcostal US-TAP was 174 cm2 (IQR 119-219 cm2; range 52-398 cm2). In all patients, the CSBA had a periumbilical distribution. In 42 of the 60 (70%) unilateral blocks, the CSBA had both an epigastric and infraumbilical component; in 12 of the 60 (20%) unilateral blocks, it covered only the epigastrium; and in 4 of the 60 (7%) unilateral blocks, it had only an infraumbilical distribution. No CSBA was found in 2 of the 60 (3%) unilateral blocks. In none of the patients did the CSBA cover the abdominal wall lateral to a vertical line through the anterior superior iliac spine.ConclusionThe subcostal US-TAP results in a heterogeneous non-dermatomal CSBA with varying size and distribution across the medial abdominal wall.© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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