TAP or Trap? - Rethinking the True Territory of the Transversus Abdominis Plane Block #BeyondTAP #AbdominalAnalgesia #RegionalAnesthesia #TAPBlock #QuadratusLumborum #QLBlock #EOIP #FascialPlaneBlocks #PainManagement #UGRA #AcutePain #AnatomyMatters #BlockSmart #SomaticVsVisceral #KnowBeforeYouBlock #MyRATips #TipOfTheDay Tip of the Day: ✨ The Transversus Abdominis Plane (TAP) block is often perceived as a comprehensive abdominal wall block. ✨ Anatomically and clinically, however, its coverage is selective, variable, and frequently incomplete. Let’s decode it logically. 🧠 Segmental - Not Complete Dermatomal Coverage 🔹 Targets anterior rami of T6–L1 within the fascial plane 🔹 Spread is plane-dependent and inconsistent 🔹 Neural branching forms a TAP plexus → dermatomal predictability drops 🔹 Upper abdominal coverage (T6–T9) is unreliable ➡️ Reality: Partial somatic sensory block - not uniform dermatomal anesthesia. 🧩 Medial Sparing - The Rectus Sheath Gap 🔹 Anterior Cutaneous Nerves (ACNs) pierce the posterior rectus sheath 🔹 TAP does not reliably block ACNs 🔹 Midline analgesia requires Rectus Sheath Block 🔹 “Medial escape zone” phenomenon ➡️ Reality : Without RSB, central abdominal wall remains inadequately covered. ⚡ Lateral Cutaneous Nerve Escape 🔹 Lateral cutaneous branches exit early from the neurovascular plane 🔹 Standard lateral TAP frequently spares them 🔹 Posterior TAP improves but does not guarantee coverage ➡️ Reality : Lateral abdominal wall analgesia may be incomplete. 💪 Muscle Innervation Overlap - No True Motor Promise 🔹 Abdominal wall muscles have overlapping segmental innervation 🔹 Blocking selected segments ≠ muscle paralysis 🔹 TAP is primarily sensory ➡️ Reality: It is not a muscle relaxation technique. 🔥 No Visceral Analgesia 🔹 Blocks somatic afferents only 🔹 Visceral pain travels via sympathetic & splanchnic pathways 🔹 Peritoneal stretch & bowel manipulation remain untouched ➡️ Reality: Not adequate as a standalone block for intra-abdominal surgery. 🤔 So Why Consider TAP at All? Because it still has value, when chosen rationally. ✅ Superficial abdominal wall procedures ✅ Part of multimodal analgesia ✅ When neuraxial is contraindicated ✅ To reduce opioid requirement ✅ When combined strategically (RSB posterior TAP) 🎯 Decision Lens 🔹 Lower abdominal superficial → TAP acceptable 🔹 Upper abdominal → EOIP preferred 🔹 Mixed somatic visceral → QL more rational 🔹 Major open abdominal → Epidural still gold standard 🔑 Take-Home ✨ TAP is not wrong - it is simply limited. ✨ It is a plane block, not a pan-abdominal solution. ✨ Choose based on pain source: somatic vs visceral vs mixed.

“🦴 From Skin to Capsule: Smart Blocks for Every Hip Cut!” #THR #RegionalAnesthesia #PENGblock #FICB #QLblock #TAPblock #LFCNblock #SmartAnalgesia #PostOpPain #OrthoAnesthesia #TipoftheDay #MyRATips Tip of the Day: The key to Post-op analgesia after Total Hip Replacement? Block what matters—based on Surgical approach & Innervation. ▶️ Anterior Approach 🔹 Joint Capsule (Anterior) – Use PENG block (targets FN, ON, AON) 🔹 Skin – Upper Incision – Subcostal (T12), Iliohypogastric (L1) – Add TAP (subcostal/lateral) or QL block (Type 1/2) 🔹 Skin – Mid/Lower Incision – IIN, GFN, LFCN → Block with FICB, TFP, or LFCN block ▶️ Anterolateral Approach 🔹 Joint Capsule (Anterior & Lateral) – Covered well by PENG block 🔹 Skin – Mostly LFCN, ± IIN/GFN – Use FICB or LFCN block – If upper extension → add TAP/QL ▶️ Posterolateral Approach 🔹 Joint Capsule (Posterior) – Minimally nociceptive → No sciatic block needed – Use PENG for anterior capsule 🔹 Skin – Upper Incision – T12, L1 (Subcostal, IHG) → TAP/QL block 🔹 Skin – Lower Incision – LFCN → Use LFCN block or high-volume FICB ▶️ Local Anesthetic Strategy 🧪 Type: Ropivacaine 0.2–0.25%, Bupivacaine 0.125–0.25% 💉 Volumes: – PENG: 20 mL – FICB: 30–40 mL – TAP/QL: 20–30 mL – LFCN: 5–10 mL My go-to hierarchy for THR analgesia: QLB > FICB > PENG LFCN "Block smart. Incision-specific. Capsule-aware. Approach-adapted."

"🎯 Cracking the QL Code: Cross-Sectional Secrets Unlocked! 🩺✨" #RegionalAnesthesia #UltrasoundTips #AnatomyInsights #QLBlock #PainManagement #TipOfTheDay #MyRATips 🩺 Tip of the Day: ✅ Cross-sectional Anatomy (T12-L1): Essential for accurate QL blocks! 🔸 At T12 Level: 🌬️ Prominent muscle: Diaphragm 🚫 QL & Psoas muscles minimally visible or absent 📍 Subcostal nerve (T12) courses anterior to QL muscle 🔸 At Lumbar Level (L1 onwards): 💪 Prominent muscles: Quadratus Lumborum & Psoas Major 🌀 Lumbar plexus forms within the Psoas Major Muscle ↗️ Plexus nerves exit laterally, crossing anteriorly over QL muscle 🚨 Lumbar nerves do not enter TAP plane (already occupied by TAP plexus—thoracoabdominal nerves) ✨ Only Iliohypogastric & Ilioinguinal nerves briefly enter TAP plane at ASIS level before becoming cutaneous 🎓 Clinical Pearl: 📚 Precise neural pathway knowledge is vital—many textbooks inaccurately depict these anatomical routes. Correct understanding is crucial for mastering QL block mechanics and ensuring successful nerve blocks! For more details, read the following article: x.com/KartikBSonawane/status…

"𝘾𝙧𝙖𝙘𝙠𝙞𝙣𝙜 𝙩𝙝𝙚 𝙌𝙇 𝘾𝙤𝙙𝙚: 𝙎𝙥𝙤𝙩 𝙩𝙝𝙚 𝙈𝙞𝙨𝙩𝙖𝙠𝙚 𝙞𝙣 𝘽𝙡𝙤𝙘𝙠 𝘼𝙣𝙖𝙩𝙤𝙢𝙮!" #Solvemypuzzle #AnatomyChallenge #RegionalAnesthesia #QLBlock #MedicalPuzzle #FigureFlaw 🧩 Dive into the intricate world of quadratus lumborum (QL) blocks. Can you decode what makes this block so effective? 🧐 Spot what's wrong in this attached figure and many similar images across various articles!

Let's understand the *Subcostal QL Block* (Anatomy, Sonoanatomy, Target Site) It's basically Subcostal approach of Anterior QL or Transmuscular QL Block. *Patient Position:* Lateral > Prone *Probe Position:* - In the Flank area over the Posterior axillary Line. - Tilting probe slightly obliquely and anteriorly towards Vertebrae. *Target Site:* LA is deposited between Hyperechoic Psoas Muscle (seen above vertebral shadows) and Hypoechoic QL Muscle lying anterior to Psoas M. Drug Should be deposited anterior to the QL between the QL muscle and the anterior layer of the thoracolumbar fascia. Observed the spread in cephalad direction close to the T12 rib with anterior displacement of the anterior layer of thoracolumbar fascia. *Coverage :* T6-L2. For more Details: Visit youtu.be/AqqBfb_C__c?si=-7O8… #subcostalQLBlock #QLBlock #AnteriorQLBlock #TransmuscularQLBlock @DrTuhinM

Obtaining "Shamrock / Clover leaf" Sign using Tracing method. Steps: 1) Keep Pt. in Lateral decubitus position. 2)Place USG probe over Umbilicus & Start moving Laterally. 3)Identify RAM - EOM, IOM,& TAM. 4) Focus on TAM & look for Tapering or Tailing of TAM upon tracing Laterally. (Towards flank) 5)After Tailing, TAM becomes thick hyperechoic line Curving over another Hypoechoic Muscle (QLM). 6) Identify QLM & differentiate it from anechoic preperiotoneal FAT layer (below TAM). 7) Identify Tip of TP below QLM, Hyperechoic Psoas muscle anteriorly over vertebral body, and hypoechoic ESP muscle posteriorly. 8)All these muscle complex with vertebra form "Shamrock Sign". #obtainingShamrockSign #Blocktober23 #QLblock #truncalblocks #anteriorabdominalscanning #Shamrocksign

When you’re teaching yourself a new fascial plane block and you FINALLY get good sonoanatomy, you press the record button! #regionalanesthesia #QLblock #lifelonglearning #MedEd #MedTwitter

What is your take on QLblock..? Does it really work..? Which one 1/2/3 or 4..? How much & what LA..? #RAlovers #Blockers #Anaesthesia #QLblock @AoraIndia @ESRA_Society See this Instagram post by @saaccacademy instagram.com/p/ClYjXnXBJai/…

**Faculty Spotlight** Dr Suwimon Tangwiwat, Secretary of @aosra_pm Listen and interact with her on Date - 30th September Hall - A Time- 11:45 - 12:00 PM She will speak on "Quadratus lumborum plane block - Why we have different approaches" #aoraaosra22 #RAIndia #QLBlock

Request all @AoraIndia fellows to read this excellent review on #QLblock by @kaohesham and @elboghdadly tinyurl.com/ykef97ee Reply with your queries, insights and experiences (with videos if possible) #aorafp @ponde_vrushali @DrRiteshRoy1 @anesthetix @DrDiveshArora

Zero postoperative pain D0,D1 and discharge home D3 via #QLblock catheter infusion for retroperitoneal CI aneurism with @LuisNav23662880 …patient permission taken ..#regionalAnaesthesia

The comparison of quadratus lumborum block and caudal block for postoperative analgesia in children undergoing inguinal hernia repair and orchiopexy surgeries. QLB was more effective. @GozenOksuz @ESchwenkMD @dr_rajgupta #QLBlock #pedspain ow.ly/KFdV50yvRnz

Anterior quadratus lumborum block analgesia for total hip arthroplasty. "QL block provided effective analgesia & decreased opioid requirements up to 48 hours after primary THA" @mail2vincechan @KalagaraHari @dr_rajgupta @ESchwenkMD #THA #QLblock #USRA ow.ly/aUie50xdWiq

@CandraBassMD Wonderful time hosting a #truncalblock workshop for my group @MEDNAX:American Anesthesiology of NC @WakeMed with @Pacira. Dynamic speaker @HoltzMaggie guided us through didactics and hands-on learning #exparel #regionalanesthesia #QLblock #ESB #opioidminimization

anyone used #TAPblock #QLblock 4 pain after lithotripsy as in this trial ncbi.nlm.nih.gov/pmc/article… (once hematoma colic from fragments ruled out of course) @nelkassabany @kaohesham @amit_pawa @docmorne @PeterMerjavy @NaveenEipe @jan1boublik @KiJinnChin @ChrisPrabhakar

I hope it clarifies some concepts, provides food for thought, and increases accessibility of this useful technique! #QLBlock anesthesiology.pubs.asahq.or…

Quadratus Lumborum Block:Anatomical Concepts, Mechanisms, and Techniques | Anesthesiology | ASA Publications ⁦@ASALifeline⁩ #QLBlock #regionalanaesthesia #postoppain anesthesiology.pubs.asahq.or…

Sunday morning regional anesthesia fun w/@jeffgadsden. Thanks for visiting us at Northside Jeff! #meded #QLblock #lifelonglearning #regionalanesthesia @NorthsideHosp

Way too logical. We need something less clear like STAR1 STAR2 and STAR3. #QLblock #QuadratusLumborum #QL123joke

Agree with everyone to an extent! More studies with #ESPblock #QLblock vs. #epidural. Still very nice to have options beyond an epidural