After sc meskipun tapblock rasanya mantapp😭

Selama hamiw kan kita periksa nder, kalau gada keluhan apapun saran aku di bidan / klinik faskes pratama yg bisa dicover bpjs. Kalau ada penyulit baru lahiran di RS nder & minta rujukan dr faskes 1 Kecuali kita kaya bisa dipertimbangkan lahiran di RSPI / Tzu Chi erascs tapblock

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.

🚀 “Fascial Highways, Not Magic Shots” - Take-Home Messages from Decoding QL Blocks #RegionalAnesthesia #PainMedicine #UltrasoundGuided #FascialPlaneBlocks #QuadratusLumborumBlock #QLB #ThoracolumbarFascia #TLF #TransmuscularQLB #AnteriorQLB #PosteriorQLB #TAPBlock #AbdominalWallAnalgesia 🧭 QLB is TAP’s evolved cousin: TAP mainly stays in the TAP plane (somatic abdominal wall), while QLB tries to “borrow” deeper fascial continuities to extend coverage. 🕸️ The thoracolumbar fascia (TLF) is the real engine: QLB success is governed more by fascial architecture than by “which nerve you think you’re blocking.” 🛣️ Anterior TLF = the main ‘fascial highway’: It connects laterally to transversalis fascia, medially to psoas fascia, and cranially toward endothoracic fascia- explaining why deeper approaches can sometimes go broader (and occasionally visceral). 🎯 If you want broader more predictable spread, think “anterior/transmuscular”: The review highlights why anterior approaches more consistently access paravertebral/lumbar plexus corridors than superficial/lateral techniques. 🧱 Lateral & posterior QLB = reliable somatic analgesia (mostly): Great for flank/lateral wall pain, but don’t expect consistent visceral cover. 🔬 T12→L1 transition is the clinical ‘game-changer’: At/after L1, the psoas is more evident and the lumbar plexus starts forming- helping explain why anterior QLB at/below L1 can be more extensive. 🧠 Stop teaching the wrong nerve story: Lumbar plexus nerves don’t just “enter the TAP.” That common schematic error leads to unrealistic expectations from TAP/lateral QLB. 🧩 Anterior QLB isn’t one block-it’s multiple sub-compartments: Small needle-tip shifts can redirect spread cranial/medial/posterior and change what you get clinically. 🔼 Want upper abdominal possible visceral component? Aim for the plane that favors cranial tracking along endothoracic continuity (subcostal/anterior variants are built for this logic). 🧷 Technique selection should be indication-driven: Lateral/posterior for somatic flank; anterior/CPPB when you need deeper/lumbar plexus or broader abdominal–pelvic coverage. ⚠️ Safety isn’t optional - anterior is closer to neuraxis/lumbar plexus: Higher risk of unintended neuraxial spread if volume/plane is wrong; lateral variants risk peritoneal/retroperitoneal breach, so dynamic US, incremental injection, and vigilance matter. 📌 Bottom line: QLB outcomes vary because anatomy fascial compliance injection dynamics vary - so reproducibility comes from precise plane selection, not from “QLB label” alone. Read in details: Indian Journal of Anaesthesia share.google/XsipICbXE3DSle7…

New research finds ultrasound-guided TAP blocks can safely reduce pain, opioid use, and hospital stays for acute pancreatitis patients in the ER. Breathe easy with this groundbreaking treatment! #TAPBlock #PainManagement #MedicalInnovation anesthesiologynews.com/a/zzE…

ظهرت تقنيات جديدة للحد من الشعور بالألم بعد العمليات الجراحية مثل تقنية #تاب_بلوك، تعرف عليها من هنا: #dailymedicalinfo #TAPBlock dailymedicalinfo.com/view-ar…

🔥🫁 "Pain at the Core: On-Arrival Blocks for Chest and Abdomen" 🧍‍♂️🛡️ #PainAtTheCore #OnArrivalBlock #TruncalAnalgesia #ChestWallBlock #AbdominalBlock #RegionalAnesthesia #ESPBlock #TAPBlock #SAPBlock #UltrasoundGuidedRA #PointOfCareBlocks #OnArrivalRA #TipoftheDay #MyRATips Tip of the Day: 🟦 Why FOCUS on Truncal Pain Early? 🫁 Chest and abdominal injuries often compromise vital functions - especially breathing, coughing, and cooperation. 🔥 Pain in these regions is often deep, diffuse, and distressing, and opioids alone may not suffice or may cause respiratory depression. 🛠️ Regional blocks offer site-specific, opioid-sparing relief that improves immediate care and downstream outcomes. 🟨 CLINICAL GOALS of Truncal On-Arrival Blocks 🫁 Restore respiratory efficiency (chest trauma, rib fractures) 🚑 Facilitate imaging, positioning, and transport 🧘 Relax abdominal guarding (peritonitis, pancreatitis) 📉 Reduce sympathetic overdrive in trauma 🫱 Enhance cooperation for procedures or airway planning 🟫 COMMON INDICATIONS 🟦 Chest Wall: Rib fractures (especially multiple) Flail chest Post-thoracostomy or chest tube placement Chest wall contusions in blunt trauma 🟨 Upper Abdomen: Blunt abdominal trauma Acute pancreatitis Upper GI perforation or distension Postoperative laparotomy or laparoscopy pain 🟧 Lower Abdomen: Inguinal hernia (painful or strangulated) Appendicitis with guarding Abdominal wall hematomas or incisional pain 🟪 BEST CHOICES 🫁 For Chest Wall Injuries: ESPB, SAPB, or ICNB. Provide broad dermatomal coverage. Safe to perform away from critical structures like the pleura. Ideal for rib fractures, flail chest, and chest tube insertion pain. 🧼 For Upper Abdominal Pain: ESPB at T6–T9 levels or TAP Block. Relieve guarding and improve respiratory effort in conditions like pancreatitis or blunt abdominal trauma. 🧩 For Lower Abdominal Conditions: TAP Block, RSB, IIN/IHN Block. Provide localized anterior abdominal wall analgesia. Suitable for inguinal hernia, appendicitis, or post-incisional pain. 🟥 ESPB: CHAMPION? ✅ Superficial and safe (away from pleura/major vessels) ✅ Wide craniocaudal spread ✅ Suitable for non-sterile or semi-sterile environments ✅ Excellent for rib fractures and abdominal wall pain ✅ Can be done quickly with or without USG 🟧 KEY PEARLS 🧼 Basic aseptic precautions suffice in emergency use 🩻 USG is ideal but can be landmark-based if skilled 🧾 Document block site, volume, drug, and response ⏱️ Reassess for conversion to longer-acting block or catheter if needed 🟫 CHEST WALL BLOCKS: RULE “Hit the Rib, Deposit the Drug” 🔹Deep SAP Block – Needle hits the rib, inject deep to serratus 🔹External Oblique Intercostal Plane Block – Target rib at anterior/mid-axillary line, inject above EO 🔹Parasternal Block – Identify rib near sternum, inject in intercostal plane 🎯A safe, reproducible approach - perfect for emergency or limited-resource settings. 🟨 ABDOMINAL WALL BLOCKS: RULE “Follow the Muscle, Find the Plane” 🔹TAP Block – Feel or visualize the abdominal wall → insert between internal oblique & transversus abdominis 🔹Rectus Sheath Block – Palpate the rectus muscle → inject posterior to it, above posterior sheath 🔹Ilioinguinal/Iliohypogastric Block – Palpate ASIS → inject in plane between internal oblique and transversus abdominis near the iliac crest 🎯Key Tip: Identify the muscle → follow its plane → deposit where spread flows freely. ✅Reliable, reproducible, and effective for anterior abdominal wall analgesia. "When pain impairs breathing or masks diagnosis, a timely On-Arrival Block for the trunk may be your best intervention - not just for comfort, but for survival."

“🦴 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."

🧪 What does epinephrine do to ropivacaine during a TAP block? In this RCT, Rozier et al. found: ✔️ No change in Cmax ⏱️ Delayed Tmax 📉 Lower Cmean ❤️ No toxicity 🔗 Read all about this study here: doi.org/10.1136/rapm-2025-10… #RAPM #TAPBlock #Anesthesia #Epinephrine

مع التقدم الطبي المذهل، ظهرت تقنيات جديدة للحد من الشعور بالألم بعد العمليات الجراحية مثل تقنية #تاب_بلوك .. تعرف على هذه التقنية بالتفصيل من هنا: #dailymedicalinfo #TapBlock dailymedicalinfo.com/view-ar…

مع التقدم الطبي المذهل، ظهرت تقنيات جديدة للحد من الشعور بالألم بعد العمليات الجراحية مثل تقنية #تاب_بلوك، وسنتعرف عليها في هذا المقال #dailymedicalinfo #TAPBlock dailymedicalinfo.com/view-ar…

Pro vs Con #ERAS debates 🥊 with @BonaldoGiulio and @Pan_Teresa_MD #carbload #TAPblock #drains @ErasSociety @pedroramirezMD

Administering TAP blocks significantly decrease opioid requirements and shorten hospital stays for patients undergoing minimally invasive hysterectomy @AAGLJMIG #jmigjc #PainManagement #TAPBlock

مع التقدم الطبي المذهل، ظهرت تقنيات جديدة للحد من الشعور بالألم بعد العمليات الجراحية مثل تقنية #تاب_بلوك .. تعرف على هذه التقنية بالتفصيل من هنا: #dailymedicalinfo #TapBlock dailymedicalinfo.com/view-ar…

مع التقدم الطبي المذهل، ظهرت تقنيات جديدة للحد من الشعور بالألم بعد العمليات الجراحية مثل تقنية #تاب_بلوك .. تعرف على هذه التقنية بالتفصيل من هنا: #dailymedicalinfo #TapBlock dailymedicalinfo.com/view-ar…

More evidence for Laparoscopic assisted transversus abdominis plane #TAPblock (vs ultrasound guided) in laparoscopic #BariatricSurgery Ping @AR_Jarrar @AdeleBudiansky HT: Algyar MF, Abdelsamee KS. BMC Anesthesiol 2024 rdcu.be/dEaJy

مع التقدم الطبي المذهل، ظهرت تقنيات جديدة للحد من الشعور بالألم بعد العمليات الجراحية مثل تقنية #تاب_بلوك .. تعرف على هذه التقنية بالتفصيل من هنا: #dailymedicalinfo #TapBlock dailymedicalinfo.com/view-ar…

تعد الأيام الأولى بعد الخضوع لأي عملية جراحية من أصعب الأيام التي تمر ببطء على صاحبها.. ولأن التكنولوجيا تأتينا بكل جديد تعرف على حقنة #تاب_بلوك للتخدير بعد جراحات البطن: #dailymedicalinfo #tapblock dailymedicalinfo.com/view-ar…

ظهرت تقنيات جديدة للحد من الشعور بالألم بعد العمليات الجراحية مثل تقنية #تاب_بلوك، وسنتعرف عليها في المقال التالي بشيء من التفصيل #dailymedicalinfo #TAPBlock dailymedicalinfo.com/view-ar…

Pre-operative vs. postoperative TAP block ⚡️ 👇🏻👇🏻👇🏻👇🏻👇🏻👇🏻👇🏻👇🏻👇🏻 #regionalanesthesia #tapblock #cholecystectomy #pain #metaanalysis @SerkanTulgarMD @DecassaiMD @BMC_series @SpringerNature doi.org/10.1186/s12871-023-0…