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Ultrasound-guided transversus abdominis plane injection with computed tomography correlation: a cadaveric study

机译:超声引导下腹部横断面注射与计算机断层扫描的相关性:尸体研究

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Background: Ultrasound-guided transversus abdominis plane (TAP) injections are increasingly being used as an alternative to traditional perioperative analgesia in the abdominal region. With the use of a "blind" TAP block technique, these procedures have had variable success in cadaver and in vivo studies. For more accurate injection with the intended medication, ultrasound guidance allows visualization of the correct layer of the abdominal wall planes in which the thoracolumbar nerves reside.Objective: To assess the spread of various volumes of contrast placed under live ultrasound guidance into the TAP using computed tomography (CT).Methods: Four TAP blocks were performed on 2 fresh frozen cadaver torsos with predetermined contrast volumes of 5, 10, 15, or 20 mL. A CT scan of the cadaver was then performed and interpreted by a musculoskeletal radiologist. This cadaver study was carried out at a tertiary care academic medical center.Results: Cranial–caudal spread of injected contrast correlated with increasing injectate volume and was roughly 1 vertebral level (end plate to end plate) for the 5 mL injection and 2 vertebral levels for the 10, 15, and 20 mL injections. However, the degree of injectate spread may be different for live patients than for cadavers.Conclusion: This study helps further the understanding of injectate spread following ultrasound-guided TAP injections. Specifically, it suggests that 15 mL provides additional cranial–caudal spread and may be an optimal volume of anesthesia.
机译:背景:超声引导的腹横肌平面(TAP)注射越来越多地被用作腹部区域传统围手术期镇痛的替代方法。通过使用“盲” TAP阻断技术,这些程序在尸体和体内研究中取得了不同程度的成功。为了更准确地注射所需的药物,超声引导可以可视化胸腰神经所在的腹壁平面的正确层。目的:使用计算机计算来评估实时超声引导下放置在TAP中的各种造影剂的分布方法:对2个新鲜的冷冻尸体躯干进行四个TAP块,预定的对比体积为5、10、15或20 mL。然后由肌肉骨骼放射科医生对尸体进行CT扫描并进行解释。这项尸体研究是在三级医疗学术医学中心进行的。结果:注射的对比剂在头尾之间的扩散与注射量的增加相关,对于5 mL注射和2椎骨水平,大约是1个椎骨水平(端板到端板)。 10、15和20 mL进样。然而,活体患者的注射扩散程度可能与尸体不同。结论:本研究有助于进一步了解超声引导的TAP注射后的注射扩散。具体来说,这表明15 mL可提供额外的颅尾扩散,可能是最佳的麻醉量。

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