L’utilizzo dell’anestesia locoregionale (ALR) è raccomandato tutte le volte possibili, a complemento delle tecniche di analgesia classica, nell’ambito di una gestione multimodale del dolore. In quest’ottica, i blocchi della parete addominale hanno un grande campo di azione, tenuto conto della frequenza e dell’intensità dei dolori postoperatori. Il transversus abdominis plane, o TAP, corrisponde al piano situato tra i muscoli obliquo interno e trasverso. A questo livello, decorrono, tra gli altri, dei rami nervosi dei nervi intercostali T9-T12 e della prima radice lombare LL’interesse clinico del TAP block è stato ben validato da studi randomizzati in cieco, dopo colectomia, isterectomia e cesareo. Numerosi altri studi e casi clinici suggeriscono l’interesse di questo blocco in tutta la chirurgia addominale sottombelicale, in particolare nella chirurgia urologica ed erniaria. Al di fuori dell’erniorrafia ombelicale semplice, questo blocco permette di assicurare un’eccellente analgesia, ma non procura un’anestesia chirurgica. L’identificazione del TAP, attraverso i reperi anatomici, nel triangolo di Petit, è aleatoria e non garantisce una sicurezza adeguata. L’ecoguida permette di visualizzare il TAP e di controllare in diretta l’iniezione di anestetici locali : questo blocco è realizzato in tutta sicurezza e con un tasso di successo molto elevato. Per questo motivo, negli ultimi anni, l’avvento dell’ecografia ha generato uno sviluppo importante del TAP block. L’apprendimento di questa tecnica ecoguidata è facile e rapido e si basa su una conoscenza semplice dell’innervazione della parete addominale e dell’organizzazione dei differenti piani muscolari.
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