Description of different ultrasound guided transversus abdominis plane block in pig cadavers : a pilot study

Objective To develop an ultrasound (US)-guided transversus abdominis plane (TAP) block in pigs. Study design Prospective, descriptive, experimental study. Animals A total of 26 hemi-abdomens belonging to 13 Seghers Hybrid cadavers. Methods The study consisted of two parts. In part 1, a preliminary anatomical understanding of the abdominal wall innervation in pigs was established (two hemiabdomens of one pig). Part 2 was divided into three phases, and a US-guided TAP technique using methylene blue dye (0.3 mL kg(-1) for each hemi-abdomen) was developed. In chronological order, a pilot study (phase I) was conducted to establish good injection points (four hemiabdomens). In phase II a two-point injection technique (10 hemi-abdomens) was performed. A cranial injection was made at two-thirds of the distance between the xyphoid process and the iliac crest, immediately ventral to the rib arch. A caudal injection was performed ventral to the last rib. In phase III a three-point injection technique was performed (10 hemi-abdomens) with an extra injection point halfway between the cranial and caudal injection point. Staining of the different nerves was recorded during dissection. Results In part 1 the nerves innervating the pig's abdominal wall, thoracic vertebrae 12-16 (T12-16) and lumbar vertebrae 1-3 (L1-3), were identified. In part 2, data from the pilot study, adequate nerve staining with the two- or three-point injection technique, were obtained in T12 (29 versus 45% respectively), T13 (29 versus 100%), T14 (73 versus 45%), T15 (75 versus 78%), T16 (58 versus 78%), L1 (100 versus 75%), L2 (88 versus 84%) and L3 (23 versus 0%). Conclusions and clinical relevance US-guided TAP block can be used in swine but only a moderate success rate for adequate nerve staining was achieved in this study. Further studies are necessary to determine a correct injection volume and assess clinical intra- and postoperative efficacy