• Takeshi Murouchi, Masanori Yamauchi, Eri Gi, Yukimasa Takada, Aki Mizuguchi, Michiaki Yamakage, and Mineko Fujimiya.
• Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo 060-8543.
• Masui. 2013 Jan 1;62(1):60-3.

BackgroundMid-axillary transversus abdominis plane block (TAP-B) and subcostal TAP-B have become well-known blocks to provide considerable analgesia for abdominal surgery. However, proper approach and adequate volume of injectate have not still been clarified. In this study, a combination of mid-axillary TAP-B and subcostal TAP-B was performed in cadavers to establish the spread of injectate and segmental nerve involvement.MethodsUltrasound-guided dye injections (10 ml each) into the TAP were performed with mid-axillary and subcostal approaches. Injections were performed for hemiabdominal walls of 4 Thiel's embalmed human cadavers. Dye spread and nerve involvement were evaluated by dissection 10 min after the injections.ResultsAll 7 hemiabdominal walls were successfully injected and dissected after 1 pilot study. Thoracic nerves (T7-12) and the first lumbar nerve (L1) were found. Segmental nerves T7 (14%), T8-11 (100%), T12 (71%), and L1 (43%)were involved.ConclusionsThis study demonstrated that the combination of ultrasound-guided mid-axillary TAP-B and subcostal TAP-B involve T8-L1 nerves. This technique can be used not only in lower abdominal surgery but also in upper abdominal surgery.

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