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Ultrasound-Guided Continuous Oblique Subcostal Transversus Abdominis Plane Blockade: Description of Anatomy and Clinical Technique
  1. Peter D. Hebbard, FANZCA*,,,
  2. Michael J. Barrington, FANZCA and
  3. Carolyn Vasey, MB, BS
  1. From the *Anaesthesia and Pain Management Unit, Department of Pharmacology, University of Melbourne;
  2. Northeast Health Wangaratta, Victoria; and
  3. Department of Anaesthesia, St Vincent's Hospital, Melbourne, Australia.
  1. Address correspondence to: Peter D. Hebbard, FANZCA, Northeast Health Wangaratta, 134 Templeton St, Wangaratta, Victoria 3677, Australia (e-mail: p.hebbard{at}


Background: Recently, ultrasound-guided transversus abdominis plane blockade for abdominal wall analgesia has been described, and it involves injection of local anesthetic into the transversus abdominis plane. The posterior approach involves injection of local anesthetic in the lateral abdominal wall between the costal margin and the iliac crest and is suitable for postoperative analgesia after surgery below the umbilicus. The subcostal approach is suitable after abdominal surgery in the periumbilical region. The subcostal block can be modified, and the needle can be introduced along the oblique subcostal line from the xyphoid process toward the anterior part of the iliac crest.

Objective: The purpose of this brief technical report was to describe in detail the anatomy and the technique of continuous oblique subcostal blockade. The goal of this approach was to produce a wider sensory blockade suitable for analgesia after surgery both superior and inferior to the umbilicus.

Conclusions: A catheter can be placed along the oblique subcostal line in the transversus abdominis plane for continuous infusion of local anesthetic. Multimodal analgesia and intravenous opioid are used in addition because visceral pain is not blocked. Continuous oblique subcostal transversus abdominis plane block is a new technique and requires both a detailed knowledge of sonographic anatomy and technical skill for it to be successful.

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  • Parts of this work have been presented at the Australian and New Zealand College of Anaesthetists, Annual Scientific Meeting 2008, the International Symposium on Ultrasound and Regional Anesthesia 2008, the 2nd Sydney Symposium on Ultrasound and Regional Anaesthesia 2008, and the International Symposium on Spinal and Paravertebral Sonography 2009.

  • The authors have no competing interests to declare.