Transversus abdominis plane block: The Holy Grail of anaesthesia for (lower) abdominal surgery

The transversus abdominis plane (TAP) block is a new, rapidly expanding regional anaesthesia technique that provides analgesia following abdominal surgery. It involves a single large bolus injection of local anaesthetic into the TAP, an anatomical space between the internal oblique and transversus abdominis muscles. This article presents the development of the TAP block over the last 10 years, with an analysis of all anatomical and case studies and randomized controlled trials, and an account of the author’s own experience. Diagrams and a detailed description of the techniques contribute to a better understanding of this block. The change in technique from landmark to ultrasound guided, the expansion of indications, and changes in local anaesthetic type and quantity are described and discussed. Furthermore, comparison with similar regional anaesthesia techniques, such as rectus abdominis sheath, paravertebral and ilioinguinal/iliohypogastric blocks, clarifies similarities and differences. Some comparison with epidural analgesia is made. The advantages and disadvantages of this block are summarized. Armed with a sound knowledge of its advantages and limitation, this promising new regional anaesthesia technique can be used successfully for intra/postoperative analgesia in abdominal surgery