Transversus Abdominis Plane (TAP) and Rectus Sheath Blocks: a Technical Description and Evidence Review

• DOI: 10.1007/s40140-019-00351-y
• Publication Date: 2019-10-25T20:32:44Z
• Authors: Vishal Uppal; Sushil Sancheti; Hari Kalagara
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 3. Good health

This article aims to review the anatomy relevant to the ultrasound techniques of the transversus abdominis plane (TAP) block and rectus sheath block (RSB). We discuss their analgesic efficacy for various surgical procedures, both as single shot and as a continuous infusion via catheters. RSB provides superior analgesia to local infiltration and has an opioid-sparing effect for umbilical surgery, laparotomy, and laparoscopic surgery. There is no high-quality evidence comparing RSB with epidural analgesia. Intermittent bolus through catheters appears to be more effective than continuous infusion for prolonged analgesia. Similarly, ultrasound-guided TAP block provides postoperative analgesic benefit after abdominal laparotomy or laparoscopy and cesarean delivery when long-acting neuraxial opioids are not used or contraindicated. Adding adjuvant such as dexamethasone and dexmedetomidine to local anesthetic prolongs the duration of TAP and RSB blocks and improves their efficacy. Use of ultrasound guidance makes the RSB and TAP blocks more reliable. Single-shot infiltration is useful for less extensive surgical procedures, while catheters are a useful alternative when thoracic epidural analgesia is contraindicated.