Anesth Pain Med.  2020 Jul;15(3):344-348. 10.17085/apm.19102.

Transversus abdominis plane block as a sole anesthetic technique for evacuation of rectus abdominis muscle hematoma - A case report -

• Kim YM
• Hyun DM
• Kim HS
• Kim JS

• KMID: 2504897
• DOI: http://doi.org/10.17085/apm.19102

Abstract

Background
Transversus abdominis plane (TAP) blocks have been used for analgesia in various abdominal surgeries. However, a TAP block as the sole anesthetic method for surgery has rarely been reported. Case: A 33-year-old breastfeeding primipara woman was admitted to the hospital due to a rectus abdominis muscle hematoma. Because the patient refused other anesthetic methods, evacuation of the hematoma was performed under an ultrasound-guided bilateral TAP block. A 23-gauge needle was inserted in an in-plane method using a linear ultrasound probe. An injection of 10 ml of 2% lidocaine was made to the right lateral TAP and the left lateral TAP. After confirming the sensory blockade of the T10 to T12 dermatomes, surgery was performed successfully. The patient’s condition stabilized during the surgery. Breastfeeding was performed on the day of surgery.
Conclusions
The evacuation of an abdominal wall hematoma in a breastfeeding patient was successfully performed under a bilateral TAP block.

Keyword

Breastfeeding; Evacuation; Hematoma; Transversus abdominis plane block; Ultrasound

Figure

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  Fig. 1. Lower rectus abdominis muscle hematoma 16 × 7.7 × 9.2 cm in size was detected by abdominal computed tomography. It developed after a lower transverse Cesarean section which was performed 17 days ago. (A) Transverse plane image. (B) Coronal plane image.

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  Fig. 2. The patient was in the supine position for the lateral transversus abdominis plane block. The black line indicates the anterolateral part of the iliac crest, right. The black dashed line indicates the lower costal margin. Ant.: anterior, Post.: posterior.

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  Fig. 3. Ultrasound view of the transversus abdominis plane block after needle insertion. The arrowheads indicate the trajectory of the 23-gauge, 60 mm quincke-type needle. EOM: external oblique muscle, IOM: internal oblique muscle, TAM: transversus abdominis muscle.

Reference

1. Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001; 56:1024–6.

2. Mishra L, Pani N, Mishra D, Patel N. Bilateral transversus abdominis plane block as a sole anesthetic technique in emergency surgery for perforative peritonitis in a high risk patient. J Anaesthesiol Clin Pharmacol. 2013; 29:540–2.

3. Lee AR, Choe YS. Anesthesia experience for open gastrostomy with ultrasound-guided unilateral subcostal transversus abdominis plane block in a high risk elderly patient: a case report. Anesth Pain Med. 2015; 5:e24890.

4. Vuong JT, McQuillan PM, Messaris E, Adhikary SD. Transversus abdominis plane block as the primary anesthetic for laparotomy. J Anaesthesiol Clin Pharmacol. 2014; 30:419–21.

5. Bihani P, Bhatia P, Chhabra S, Gangwar P. Can ultrasound-guided subcostal transverse abdominis plane block be used as sole anesthetic technique? Saudi J Anaesth. 2017; 11:111–3.

6. Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS; Maternal Health Study Group of the Canadian Perinatal Surveillance System. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007; 176:455–60.

7. Hatjipetrou A, Anyfantakis D, Kastanakis M. Rectus sheath hematoma: a review of the literature. Int J Surg. 2015; 13:267–71.

8. Jankovic Z. Transversus abdominis plane block: the holy grail of anaesthesia for (lower) abdominal surgery. Period Biol. 2009; 111:203–8.

9. Junge J, Inchiosa MA, Xu JL. Exploring the transversus abdominis plane block in cesarean sections and the subsequent toxicity risk to neonates via breast milk. J Anaesthesiol Clin Pharmacol. 2019; 35:153–6.

10. Kerai S, Dabas N, Sehrawat L, Gupta N. Transversus abdominis plane block as sole anaesthetic technique for inguinal hernia repair in two patients having complex medical conditions. Indian J Anaesth. 2015; 59:754–6.

11. Herring AA, Stone MB, Nagdev AD. Ultrasound-guided abdominal wall nerve blocks in the ED. Am J Emerg Med. 2012; 30:759–64.

12. Tsai HC, Yoshida T, Chuang TY, Yang SF, Chang CC, Yao HY, et al. Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int. 2017; 2017:8284363.

13. Tran TM, Ivanusic JJ, Hebbard P, Barrington MJ. Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study. Br J Anaesth. 2009; 102:123–7.

14. Støving K, Rothe C, Rosenstock CV, Aasvang EK, Lundstrøm LH, Lange KH. Cutaneous sensory block area, muscle-relaxing effect, and block duration of the transversus abdominis plane block: a randomized, blinded, and placebo-controlled study in healthy volunteers. Reg Anesth Pain Med. 2015; 40:355–62.

15. Oliveira MRE, Santos MG, Aude DA, Lima RME, Módolo NSP, Navarro LH. Should maternal anesthesia delay breastfeeding? A systematic review of the literature. Rev Bras Anestesiol. 2019; 69:184–96.