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Intraindividual variation of the transversus abdominis plane block: an exploratory study in healthy volunteers
  1. Christian Svendsen Juhl1,
  2. Christian Rothe1,
  3. Kion Støving1,
  4. Eske K Aasvang2,3,
  5. Charlotte V Rosenstock1,
  6. Kai Henrik Wiborg Lange1 and
  7. Lars Hyldborg Lundstrøm1
  1. 1 Department of Anesthesia and Intensive Care, Nordsjaellands Hospital, Hillerod, Denmark
  2. 2 Department of Anesthesiology, Center for Cancer and Organ Diseases, Rigshospitalet, Copenhagen, Denmark
  3. 3 Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Christian Svendsen Juhl, Department of Anesthesia and Intensive Care, Nordsjaellands Hospital, Hillerod DK-3400, Denmark; christiansjuhl{at}


Introduction The transversus abdominis plane block is widely used in postoperative pain management after abdominal surgery. However, large interindividual variation in the cutaneous distribution area of the block has been demonstrated. The purpose of the present study was to explore the reproducibility of the block by determining the intraindividual variation when repeating the block on two separate days.

Methods Ultrasound-guided posterior transversus abdominis plane blocks were performed in 16 healthy volunteers and repeated after at least 2 days. Cutaneous sensory block areas and distributions, thresholds for mechanical stimulation, abdominal muscle thicknesses at rest and during maximal contraction, waist circumferences and block duration times were measured on both days. Outcome measurements from the 2 days were compared using a one-sample t-test and intraclass correlation coefficients were calculated for each parameter. Agreement was evaluated visually using Bland-Altman plots.

Results None of the mean values of the outcome measurements differed significantly between the 2 days. Intraclass correlation coefficient was 0.75 (moderate-to-good reliability) for lateral abdominal muscle thickness during maximal contraction, but ranges from −0.07 to 0.67 were found for all other outcome measurements (poor-to-moderate reliability).

Conclusion We found a moderate-to-good reproducibility for lateral abdominal muscle thickness during maximal voluntary contraction, but a moderate-to-poor reproducibility for all other block characteristics. However, the cutaneous distribution of the block was still located primarily inferior to a horizontal line through the umbilicus and lateral relative to a vertical line through the anterior superior iliac spine.

  • truncal blocks
  • postoperative pain
  • pain medicine
  • interventional pain management

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  • Presented at Part of this work was presented in ‘Cutaneous Sensory Block Area, Muscle-Relaxing Effect, and Block Duration of the Transversus Abdominis Plane Block: A Randomized, Blinded, and Placebo-Controlled Study in Healthy Volunteers. Støving K, Rothe C, Rosenstock CV, Aasvang EK, Lundstrøm LH, Lange KH. Reg Anesth Pain Med 2015;40(4):355-62.

  • Contributors CR, KHWL, KS, LHL, EAK and CVR planned and designed the study. CR, KS and KHWL conducted the experiments. CSJ and LHL analysed and interpreted the data and drafted the first version of the manuscript. All authors critically revised the manuscript. All authors approved the final version of the manuscript.

  • Funding This work was locally funded by grants from Nordsjællands Hospital, Hillerød, Denmark.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request to the corresponding author. The corresponding author can be contacted by the e-mail stated in the article. Data include deidentified data and deidentified clinical photos. Reuse of data will be permitted upon request if the authors find the request meaningful and appropriate.