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Cutaneous sensory block area of the ultrasound-guided subcostal transversus abdominis plane block: an observational study
  1. Christopher Blom Salmonsen1,2,
  2. Kai Henrik Wiborg Lange3,4,
  3. Christian Rothe3,
  4. Jakob Kleif1,4 and
  5. Claus Anders Bertelsen1,4
  1. 1 Department of Surgery, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
  2. 2 Graduate School, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  3. 3 Department of Anesthesiology, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
  4. 4 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Christopher Blom Salmonsen, Department of Surgery, Nordsjaellands Hospital, Hillerod 3400, Denmark; christopher.blom.salmonsen{at}


Background and objectives The transversus abdominis plane block (TAP) can be applied using different approaches, resulting in varying cutaneous analgesic distributions. This study aimed to assess the cutaneous sensory block area (CSBA) after ultrasound-guided TAP (US-TAP) using the subcostal approach.

Methods Thirty patients undergoing elective laparoscopic cholecystectomy received a subcostal US-TAP with 20 mL 2.5 mg/mL ropivacaine bilaterally. Measurements were performed 150 min after block application. The CSBA was mapped using cold sensation and a sterile marker, photodocumented, and transferred to a transparency. The area of the CSBA was calculated from the transparencies.

Results The median CSBA of the subcostal US-TAP was 174 cm2 (IQR 119–219 cm2; range 52–398 cm2). In all patients, the CSBA had a periumbilical distribution. In 42 of the 60 (70%) unilateral blocks, the CSBA had both an epigastric and infraumbilical component; in 12 of the 60 (20%) unilateral blocks, it covered only the epigastrium; and in 4 of the 60 (7%) unilateral blocks, it had only an infraumbilical distribution. No CSBA was found in 2 of the 60 (3%) unilateral blocks. In none of the patients did the CSBA cover the abdominal wall lateral to a vertical line through the anterior superior iliac spine.

Conclusion The subcostal US-TAP results in a heterogeneous non-dermatomal CSBA with varying size and distribution across the medial abdominal wall.

  • analgesia
  • anesthesia, local
  • nerve block
  • pain management
  • ultrasonography

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  • Contributors CBS: conceptualization, methodology, formal analysis, investigation, resources, data curation, writing—original draft, writing—review and editing, visualization, project administration; KHWL: conceptualization, methodology, validation, writing—review and editing; CR: conceptualization, methodology, validation, writing—review and editing; JK: methodology, writing—review and editing; CAB: conceptualization, methodology, writing—review and editing, supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.