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LETTER TO THE EDITOR

The Transversus Abdominis Plane Block

Anaesthetic Department; Royal Glamorgan Hospital; Anaesthetic Journal Club, UK; Ynysmaerdy, Llantrisant, UK; simon.anke{at}ntlworld.com

To the Editor:

We have two questions regarding the report by McDonnell et al. describing the efficacy of transversus abdominis plane block after large bowel abdominal surgery (1). First, the authors describe the site of injection as "via the triangle of Petit," defining the borders of this triangle as the latissimus dorsi muscle posteriorly, the external oblique anteriorly, and the iliac crest forming the base. When discussing their subsequent method of block we are unclear as to how the needle traverses the external oblique muscle when it only forms the anterior border of the triangle. Indeed, the authors acknowledge the early work of Dr. Rafi, who first described this block, and who clearly states that the "floor of the triangle (of Petit) is the internal oblique muscle (2)."

Our second question concerns the authors assertion that the "lumbar triangle of Petit offers an easily identifiable, fixed and palpable landmark," and is therefore an improvement on previous descriptions of abdominal field blocks. They claim that "in all patients randomized to receive transversus abdominis plane block, the triangle of Petit was located easily on palpation." However, from our own experience of an admittedly fairly obese population we find these landmarks anything but easy to identify. Again, the original author describing this block admits "this block may not be easy in obese patients because of difficulty in identifying landmarks (2)."

Thus we feel that there is a danger of overestimating the ease of this block in the obese population and a potential inconsistency between the anatomical description and subsequent method described of administering the transversus abdominis plane block.

REFERENCES

1. McDonnell JG, O'Donnell B, Curley G, et al. The analgesic efficacy of transverses abdominis plane block after abdominal surgery: a prospective randomized control trial. Anesth Analg 2007;104:193–197.[Abstract/Free Full Text]
2. Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 2001;56:1024–6.[Web of Science][Medline]

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