Ultrasound-guided bilateral dual transversus abdominis plane block: a new four-point approach

Background: We describe a new ultrasound‐guided bilateral dual transversus abdominis plane block. Our hypothesis was that we could anaesthetize both the upper (Th6–Th9) and the lower (Th10–Th12) abdominal wall bilaterally using a four‐point single‐shot technique to provide effective post‐operative analgesia. Methods: A prospective cohort of 25 recovery room patients was included. They had undergone major open or laparoscopic abdominal surgery under general anaesthesia and had severe post‐operative pain. The blocks were conducted using a high‐frequency linear transducer and a 22 G, 80‐mm‐long needle. The needle was inserted in‐plane from medial to lateral for each injection. Fifteen millilitres of bupivacaine 2.5 mg/ml was injected at each of the four sites. Results: Block performance took on average 16 min (range 10–20 min). The 25 patients reported a reduction of their maximum pain (visual analogue scale 0–10) from a mean of 8.2 to a mean of 2.2 10 min after block performance (P