Table of Contents
Video Description
This video discussed the role of Transversus Abdominis Plane TAP Block in both Obstetrics and Gynecology.
Presented By
Affiliations
University of Ottawa, The Ottawa Hospital, KK Women’s and Children’s Hospital
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Summary:
- By numbing specific abdominal nerves, TAP blocks offer targeted pain relief for up to 24 hours after gynecologic and obstetric surgeries.
- Patients experience less pain, reduced reliance on oral medications, fewer side effects, and faster recovery times.
- TAP blocks are minimally invasive and carry low risks when performed by trained professionals.
- Unlike epidurals or systemic painkillers, TAP blocks provide localized relief with fewer side effects.
- With growing recognition of their benefits, TAP blocks may soon become a standard pain management technique in OBGYN care.
The Role of TAP Block in OBGYN
If you’ve ever worried about pain after surgery, here’s some good news—modern techniques like the Transverse Abdominis Plane (TAP) block can help. In this simple procedure, a doctor or surgeon delivers medication directly into your abdomen, where it goes to work blocking pain signals from reaching your brain.
TAP blocks are a very safe and effective way to reduce pain after gynecologic and obstetric surgeries. Having a TAP block can help reduce your need for oral medications after your surgery, shorten your recovery time, and help you feel better faster. That’s why they’re increasingly recommended for patients who have obstetric procedures.
In addition to the article below, the video on this page will help you learn more about the role of TAP blocks in OBGYN. For more resources on gynecological care, explore our other CanSAGE videos.
What Is a TAP Block?
A TAP block is a type of targeted pain relief that works by numbing specific nerves in your abdomen. Typically, a doctor delivers the medication directly to the area while you’re still asleep. Once the TAP block takes effect, it will provide effective pain relief in the area for up to 24 hours.
Pain management is the number one reason doctors recommend TAP blocks for patients who have complex cesarean sections, hysterectomies, and laparoscopic procedures, often in cases where larger incisions are necessary. Reducing your pain after surgery means less reliance on pain medications and a more comfortable recovery.
How Does a TAP Block Work?
Think of TAP blocks as a way to turn off pain signals in your abdomen. They’re somewhat similar to the local anesthesia a doctor or dentist might use before stitching a wound or filling a cavity. In fact, topical products like oral numbing gel for toothaches work in a similar way.
Unlike these common examples, TAP blocks last much longer and specifically target the area of your body most affected by your surgery. They also don’t need to be re-applied to provide relief.
TAP Block Techniques
There are two main techniques for performing a TAP block: ultrasound-guided (more precise) and surface landmark (less precise, but more hands-on). Both can be effective.
Ultrasound-Guided TAP Block
- Your doctor uses an ultrasound machine to view a real-time image of your abdomen.
- Once the right location is identified, a thin needle is guided into the area.
- The anaesthetic is carefully injected, then the needle is removed.
Surface Landmark TAP Block
- Your doctor uses their knowledge of anatomy to feel for the correct spot.
- These landmarks help your doctor identify the right area for injection.
- Once the right location is identified, a thin needle is guided into the area.
- The anaesthetic is carefully injected, then the needle is removed.
What to Expect
A TAP block may be performed under either general or regional anesthesia. It’s a quick procedure, usually done while you’re already in the operating room.
The sides of your abdomen will be gently washed with antiseptic to keep the area sterile. Then, your anesthesiologist will numb the area before proceeding with the TAP block. By the time you wake up in the recovery area, the medication will already be working to reduce your pain.
Why Might Your Doctor Recommend a TAP Block?
If your doctor recommends a TAP block, it’s because they carefully weighed the risks and benefits and came to the conclusion that it’s a safe and effective choice for you. TAP blocks are not needed after most minimally invasive gynecologic surgeries, or after straightforward cesarean sections. In general, TAP blocks offer three distinct benefits:
- Better pain control. You’ll likely feel less pain after surgery, making it easier to move, rest, and recover.
- Fewer side effects. By reducing the need for strong painkillers, it can also lower the risk of side effects like drowsiness or nausea.
- Faster recovery times. Effective pain control helps patients heal faster with less discomfort.
TAP blocks can also shorten your total recovery time. In some cases, you may even be able to leave the hospital sooner, depending on your procedure.
Are There Any Risks?
TAP blocks are considered very safe when performed by a trained professional. Like any medical procedure, there are risks—but most are very minor.
- The block might not work as expected. If this happens, you may need a different pain management strategy or another procedure, like an epidural.
- Mild infection at the injection site. Your care team will monitor you for symptoms like these and show you how to keep the site clean.
- Too much anesthetic used. Your care team will accurately calculate the amount of anesthetic to be injected prior to performing a TAP block to prevent this from occurring.
Serious complications like allergic reactions, bleeding, or injury to nearby organs are very rare. Your care team will carefully assess these risks with you before your procedure. If you have questions or concerns, this is a great time to raise them.
When Might a TAP Block Not Be Recommended?
TAP blocks may not be suitable for some patients. While true contraindications are also very rare, you might not be able to have a TAP block if any of these scenarios apply.
- Allergies. If you’re allergic to local anesthetics, your doctor might recommend another option.
- Infection. If you have an infection where the injection would go, you may not be able to have a TAP block.
- Bleeding disorders. If you have a bleeding disorder, like Von Willebrand disease or Factor V Leiden, TAP blocks might not be the right choice.
Your doctor and surgical care team will work closely with you to choose the safest and most effective approach.
How Does a TAP Block Compare to Other Pain Management Options?
A TAP block is a valuable option for managing post-surgical pain—but it isn’t the only option available. Think of it as one tool in a toolbox of options we use to keep you as comfortable as possible after your surgery. Here’s how the most common options compare.
How Tap Blocks Compare to Other Options
- TAP Block vs. Epidural Analgesia: TAP blocks numb specific nerves in the abdomen to give you targeted relief. Epidurals affect a larger area and have a higher risk for side effects.
- TAP Block vs. Wound Infiltration: A TAP block targets deeper nerves for more comprehensive pain relief. Wound infiltration is much more surface-level and doesn’t last as long.
- Tap Block vs. Systemic Painkillers: TAP blocks work locally, which means fewer side effects like grogginess or an upset stomach.
In some cases, your doctor may recommend a different pain management plan. Ask for clarification if you have questions or want to explore these options.
The Future of TAP Blocks in OBGYN
More doctors recognize the benefits of TAP blocks every day. While they aren’t available from every provider just yet, awareness of the benefits they carry for patients is growing.
Research strongly supports the use of TAP blocks in obstetrics and gynecology already. Newer studies continue to prove how this technique can help patients recover more comfortably with fewer problems.
TAP Blocks Can Help You Recover Faster
The TAP block is a safe, effective way to reduce pain and improve recovery after surgery. If you’re planning a procedure, talk to your doctor about whether this option is right for you. It might make a big difference in how you feel and help you recover faster!
Resources:
- University Health Network, and TGH Acute Pain Service. “Managing Your Pain with Transversus Abdominis Plane (TAP) Blocks.”
- ASRA Pain Medicine. “How I Do It: TAP Block.”
- Science Direct. “Ultrasound-guided transversus abdominis plane block is an effective opioid-sparing alternative to epidural anesthesia in open abdominal aortic aneurysm repair.”
- BMC/SpringerNature. “Bilateral transversus abdominis plane (TAP) block reduces pain and the need for additional analgesics after elective cesarean section
- University of Toronto. “IIIH and TAP Blocks”
Video Transcript: The Role of TAP Block in OBGYN
KK Women’s and Children’s Hospital and the Ottawa Hospital Research Institute jointly present The Role of TAP Block in Obstetrics and Gynaecology. The objectives are to demonstrate the technique of transversus abdominis plane block and review its role and clinical utility in obstetrics and gynecology.
TAP block is widely used to provide analgesia to the anterolateral abdominal wall. Recent literature suggests that this block may be used to help decrease postoperative pain in laparotomy for gynaecologic surgery, and may help with earlier discharge. Knowledge of the technique for this block may assist the gynecologist and anaesthesiologist to help provide this option for a greater number of patients.
It is important to understand the anatomical relationship of the musculature and nerves of the abdominal wall. The musculature comprises of the external oblique, internal oblique and the transversus abdominis muscles. A transversus abdominis plane is a special plane that lies between the internal oblique and transversus abdominis.
The sensory supply of the anterolateral abdominal wall arises from the anterior rami of the lower sixth thoracic nerves and first lumbar nerve. The branches traverse the transversus abdominis plane to supply the skin, muscle and parietal peritoneum.
T7 to T9 supplies the skin above the umbilicus, T10 supplies the umbilicus, whereas T11, T12, the iliohypogastric and ilioinguinal nerve supply the skin below the umbilicus.
TAP block is a fascial plane technique where a large amount of local anesthetic agent is injected into the transversus abdominis plane to achieve sensory blockades of mid-lower thoracic and upper lumbar nerves.
The equipment required includes aseptic skin preparation, sterile gloves, a 20 ml syringe, 22 gauge spinal needle and long-acting local anesthetic agents such as ropivacaine and bupivacaine.
In the operating room setting, patient-monitoring equipment and resuscitation equipment would be available. For the ultrasound guided technique, an ultrasound machine with high frequency linear transducer with a sterile probe cover is required.
There are two techniques to perform this block, the surface landmark technique and the ultrasound guided technique. The lumbar triangle of the petit is an important anatomical landmark. It is bound by the external oblique anteriorly, the latissimus dorsi posteriorly, and the iliac crest inferiorly.
After aseptic in preparation, the needle is inserted perpendicularly to the skin. Two pops are felt by the operator as the needle is advanced, the first as the needle pierces the fascial extension of the external oblique, and the second as the needle pierces a fascial extension of the internal oblique. The needle reaches the transversus abdominis plane. And it’s important to aspirate before injecting 20 ml of local anesthetic per side.
TAP block done under ultrasound guidance has the advantage of visualizing the needle during insertion to ensure correct placement. This supports injuries and increases success rates. The operator scans from the midline of the abdominal wall towards the area between the iliac crest and the costal margin in the midaxillary line.
The three muscle layers can be seen running parallel to one another, and the transversus abdominis plane can be identified between the internal oblique and transversus abdominis. The needle is inserted anterior to the transducer to allow an in plane view of the needle as it advances through the transversus abdominis plane. Upon injection, the fascial plane is seen to separate and form a hypoechoic elliptical shape between the internal oblique and transversus abdominis.
The absolute contraindications of TAP block are patient refusal, allergic to local anesthetic, a localised infection over the injection point. Relative contraindications include coagulopathy and surgery performed at the site of injection.
TAP block is generally safe, with few complications. Possible complications include failure of the block, bleeding, infection, local anesthetic toxicity, intraperitoneal injection and visceral injury. There have been case reports of bowel hematoma, liver laceration and intrahepatic injection.
TAP block can be used for enhanced analgesia after surgery. It has been shown to lower postop opioid requirements, which reduces respiratory depression and improves pulmonary mechanics. As visceral pain is not blocked, other modes of analgesia, such as oral analgesia and patient-controlled analgesia will still play an important role in postop pain management.
The role of TAP block has been proven in lower abdominal surgeries as part of a multimodal analgesia regimen. Studies have shown that TAP block provided reliable blockade to levels T10 to L1. There was evidence for a reduction in postop pain and opioid requirement in the immediate postoperative period, although these effects are not sustained beyond that.
These blocks are also superior to wound site infiltration with a local anesthetic. However, there was less evidence for laparoscopy, and more well-designed randomized trials are needed. For cesarean sections, evidence suggests that TAP block reduced pain scores and analgesic requirements in patients who received spinal anesthesia, but these benefits were not present in patients who received intrathecal morphine.
To summarise, TAP block is generally safe, efficacious, and technically simple to perform, with low complication rates. In recent years, numerous publications have shown the potential for TAP block in postop pain management. However, it remains underutilized in obstetrics and gynecology. With more research, education and training in its use, it can be more widely incorporated into postoperative multimodal pain management pathways. Thank you.