Regional anesthesia - TAP block.

Introduction: TAP (transversus abdominis plane block) is part of multimodal postoperative analgesia used in various gynecological, abdominal and urological surgeries. Transverse abdominis plane (TAP) block is a type of peripheral nerve block which involves the innervation of the nerves covering the anterior abdominal wall (T6-L1 anterior branch). It contains intercostal, subcostal, iliohypogastric, and ilioinguinal nerves. They are responsible for the innervation of the skin, muscles and parietal peritoneum of the anterior and posterior abdominal wall. As part of multimodal analgesia, it accelerates recovery and mobilization of the patient, reduces stress response, and significantly minimizes and eliminates the use of opioids in postoperative analgesia, thus reducing all their side effects (sedation, vomiting, reduced intestinal motility, negative effects during the infant breastfeeding). It is done preoperatively before surgical incision, or most often, at the end of surgical procedure, before the patient's awakening. Before the TAP block, the written consent of the patient should be obtained and the possible risks, benefits, alternatives of pain therapy should be discussed. Contraindications are absoule and they involve patient's refusal, allergy to local anesthetic, infection at the site of the block. Coagulopathy and surgery at the site of the block are relative. Materials and methods: the following is required for TAP block: ultrasound-linear probe (10-14Hz), sterile cover, gel. The aria is aseptically cleaned, sterile gloves are used, a local anesthetic, usually 0.25% of ropivacaine/bupivacaine/levobupivacaine, is loaded into a 20ml syringe, and with the help of 50-100mm (22-25G) block needles the prescribed dose for TAP block is administered. Monitoring is also required, as well as resuscitation equipment and lipid emulsion. Ultrasound identifies 3 muscles of the abdominal wall, externus obliqus (EO), internus obliqus (IO), transversus abdominis (TA). The method itself is simple; with the ultrasound quidance, the needle is placed between the IO and the TA, the fascia is pierced and a local anesthetic is applied. There are several approaches with respect to the anatomical location of the block: subcostal, lateral and posterior approache, which can subsequently be combined depending on surgical field, and thus we have unilateral blocks, dual and bilateral TAP blocks. Rare complications include: failure, bleeding (hematoma), infection, LA systemic toxicity, intraperitoneal injection, visceral injury (intestines, liver), transient nerve injury. Conclusion: TAP block as a multimodal analgesia is the most optimal when applied after a cesarean section, it significantly reduces postoperative pain, delays the time to the first, reduces the total consumption of analgesics, accelerates mobilization and facilitates breathing and expectoration. TAP block is an alternative to spinal morphine application for postoperative analgesia. Safe, with very few complications, efficient, easy to perform and inexpensive. Ultrasound increases the success of the block and minimizes complications!. [ABSTRACT FROM AUTHOR]