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ANALGESIA

An Anatomical Study of the Transversus Abdominis Plane Block: Location of the Lumbar Triangle of Petit and Adjacent Nerves

Zorica B. Jankovic, MD, PhD^*, Frances M. du Feu, and Patricia McConnell, BSc, PhD

From the *Department of Anaesthesia, St James's University Hospital, Leeds, UK; and Institute of Membrane and Systems Biology, University of Leeds, Leeds, UK.

Address correspondence and reprint requests to Dr. Zorica B. Jankovic, Department of Anaesthesia, Lincoln Wing, St James's University Hospital, Beckett St., Leeds LS9 7TF, UK. Address e-mail to Zorica.Jankovic{at}leedsth.nhs.uk.

Abstract

BACKGROUND: The transversus abdominis plane (TAP) block is a new technique for providing analgesia to the anterior abdominal wall. Most previous studies have used the lumbar triangle of Petit as a landmark for the block. In this cadaveric study, we determined the exact position and size of the lumbar triangle of Petit and identified the nerves affected by the TAP block.

METHODS: The position of the lumbar triangle of Petit was assessed unilaterally in 26 cadaveric specimens relative to reliably palpable surface landmarks. In addition, a series of dissections were performed to explore the course of the nerves blocked by the TAP.

RESULTS: The mean distance from the midaxillary line along the iliac crest to the center of the base of the lumbar triangle of Petit at the level of the subcutaneous tissue and over the skin surface was 6.9 cm (range, 4.5–9.2 cm) and 9.3 cm (range, 4–15.1 cm), respectively. The center of the lumbar triangle of Petit was 1.4 cm above the iliac crest. The depth of the TAP at the lumbar triangle of Petit position was 0.5–4 cm and at the midaxillary line it was 0.5–2 cm. The average size of the lumbar triangle of Petit was 2.3 cm x 3.3 cm x 2.2 cm, with an average area of 3.63 ± 1.93 cm². The three cadaveric specimens we explored showed the nerves blocked by TAP passed lateral to the triangle. An incidental finding was that in 66% of specimens the lumbar triangle of Petit contained small branches of the subcostal artery.

CONCLUSIONS: The lumbar triangles of Petit found in the specimens in this study were more posterior than the literature suggests. The position of the lumbar triangle of Petit varies largely and the size is relatively small. The relevant nerves to be blocked had not entered the TAP in the specimens in this study at the point of the lumbar triangle of Petit. At the midaxillary line, however, all the nerves were in the TAP.