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3. Chặn ngang bụng Plexus | 37 (Jankovic 2009). Sự hiện diện của các mô mỡ đáng kể Cũng Thay đổi vị trí. Kết quả là, rất khó để tìm thấy những hình tam giác chỉ trên sự xem mạch. | 3. Transverse Abdominal Plexus Block 37 Jankovic 2009 . The presence of adipose tissue also changes the position significantly. As a result it is difficult to find the triangle solely on palpation. Ultrasound visualization also is poorly achievable. Moreover the lumbar triangle may frequently contain small branches of the subcostal arteries Jankovic 2009 . In an anatomical study in 17.5 of specimens no triangle was found because the latissimus dorsi was covered by the EOM Loukas 2007 . Finally unexpected lumbar hernias may be found in 1 of patients Burt 2004 . Figure 3.1 - Triangle of Jean-Louis Petit. Ultrasound-guided Transverse Abdominal Plexus Block Ultrasounds can overcome the problem of impalpable muscle landmarks because they allow real-time visualization of tissues of the needle and of the spread of the local anesthetic Figure 3 2 3 6 hisd is .trial version www.adultpdf.com 38 Ultrasound Blocks for the Anterior Abdominal Wall Figure 3.2 - The abdominal wall visualized from different positions. Preoperative block administration is recommended as tissue visualization with ultrasounds may be impaired after surgery and tissue manipulation. Moreover late persistence of elevated local anesthetic levels in the plasma after abdominal blocks have been shown. A traditional or classical TAPB may be performed by injecting the local anesthetic between costal margin and iliac crest at the mid-axillary or at the anterior axillary line Figure 3.3 3.4 . When the transducer is positioned between costal margin and iliac crest at the mid-axillary or the anterior axillary line the three muscular layers of the abdominal wall will be seen on the screen Figure 3.2 . The EOM IOM and the TAM are seen as hypo-echoic longitudinal bands Figure 3.5 . The IOM is the thickest and the TAM is the deepest. Muscular fascias between the muscles are seen as hyper-echoic and hyper-lucent. This is trial version www.adultpdf.com 3. Transverse Abdominal Plexus Block 39 Figure 3.3 - Transducer .
