ABSTRACT
BACKGROUND: Any landmark-based regional anaesthetic technique raises two important issues. The first is the accuracy of placement of the needle and thus the local anaesthetic in a 'blind' technique and the second is the potential for damage to adjacent structures. We designed a prospective, blinded study in an adult general surgical population to evaluate with ultrasound the placement of the needle tip and local anaesthetic during transversus abdominis plane (TAP) blocks using the landmark-based 'double-pop' technique. METHODS: After induction of general anaesthesia, 36 adult patients had a TAP block performed bilaterally using the standard landmark-based technique. Ultrasonography was then used to record the actual needle position and local anaesthetic spread. The anaesthetist performing the block was blinded to the ultrasound images. RESULTS: Thirty-six adult patients were included in the study, which was terminated early due to what was considered an unacceptably high level of peritoneal needle placements. The needle tip and local anaesthetic spread were in the correct plane in only 17 (23.6%) of the injections. In the remaining 55 (76.4%), the needle was in the subcutaneous tissue 1 (1.38%), external oblique muscle 1 (1.38%), plane between the external and internal oblique muscles 5 (6.94%), internal oblique muscle 26 (36.1%), transversus abdominis muscle 9 (12.5%), and peritoneum 13 (18%). CONCLUSIONS: We conclude that the needle and local anaesthetic placement using the standard landmark-based approach to the TAP block is inaccurate, and the incidence of peritoneal placement is unacceptably high.
Subject(s)
Abdominal Wall/innervation , Nerve Block/methods , Abdominal Wall/diagnostic imaging , Adult , Aged , Aged, 80 and over , Anesthesia, General/methods , Anesthetics, Local/administration & dosage , Anesthetics, Local/pharmacokinetics , Clinical Competence , Female , Foreign Bodies/etiology , Humans , Male , Middle Aged , Needles , Nerve Block/adverse effects , Nerve Block/standards , Peritoneum , Prospective Studies , Ultrasonography , Young AdultABSTRACT
Clinical patterns and manner of presentation of vitiligo in 200 cases have been studied. Females have a slightly higher preponderance. Majority (66%) of the patients had generalized vitiligo. Lower extremity was the most common (30%) site of involvement. Family history was positive in 24% of cases. Leukotrichia (44%) and Koebner phenomenon (30%) were the associated cutaneous findings.
