PMC5292833_01
(a) Placement of ultrasound-guided probe (b) incisional hernia
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F1
Ultrasound abdomen showed a defect of 7 cm in rectus sheath with herniation of omentum and bowel loops [Figure 1]. TAP block was given using ultrasound system (GE Healthcare, USA) by the technique described by Hebbard et al. The USG probe (5-10 MHz frequency) was placed obliquely over the anterior abdominal wall along the subcostal margin near the midline [Figure 1] and moved laterally to identify neurofascial plane between the rectus and transversus abdominis muscle.
(A) Direction of needle advancement (B) expansion of intermuscular plane by injectate
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F2
A 100 mm long and 22 gauge block needle (Sonoplex, Pajunk, Germany) was advanced in the plane of USG beam to approach TAP plane and 20 ml 0.25% bupivacaine with 30 microg clonidine was injected bilaterally while observing the expansion of intermuscular plane by injectate [Figure 2].