Continuous Transversus Abdominis Plane Block

Abstract

A kit is provided for performing an ultrasound-guided transversus abdominis plane (TAP) procedure. The kit includes a container having a fluid delivery needle with a length and gauge for penetration into a patient's TAP. An extension set is included having a distal end that mates with the fluid delivery needle. A sheath is included having a size and length such that the needle slides into sheath and extends distally beyond a distal end of the sheath. A TAP catheter is included having a size and length so as to slide through the sheath. The TAP catheter has a reservoir with a defined fill volume and flow rate for delivery of a local anesthetic through said catheter.

What is claimed is: 
     
         1 . A procedure for performing an ultrasound-guided transversus abdominis plane (TAP) procedure with a kit,
 wherein the kit includes:
 a container; 
 a fluid delivery needle provided in the container and having a length and gauge for penetration into a patient's TAP, the fluid delivery needle having a tissue piercing distal tip configured for push-advancement into a TAP plane of a patient and direct delivery of a fluid through the needle to create a liquid pool in the TAP, the fluid delivery needle having a handle at a proximal end thereof that extends radially outward from an axis of the fluid delivery needle; 
 an extension set provided in the container and having a distal end that mates with the fluid delivery needle; 
 a sheath provided in the container and formed of a flexible material so as to conform to the patient's TAP, the sheath having a handle at a proximal end thereof and a size and length such that the needle slides into the sheath and extends distally beyond a distal end of the sheath as the needle and sheath are advanced together into the TAP with the needle handle engaged against the sheath handle, the sheath handle extending outward from an axis of the sheath radially beyond the needle handle; a catheter having a size and length so as to slide through the sheath, the TAP catheter having a reservoir with a defined fill volume and flow rate for delivery of a local anesthetic through the catheter; 
 the procedure further comprising: 
 scanning a patient's abdomen with an ultrasound probe, and identifying and marking the external oblique, internal oblique, and TAP; 
 placing the introducer sheath over the fluid delivery needle such that the distal end of the needle extends beyond the distal end of the sheath, the needle having echogenic properties for ultrasound imaging; 
 ultrasonically guiding the needle and sheath into the TAP; 
 injecting a local anesthetic or saline/anesthetic combination through the needle and creating a liquid pool in the TAP; 
 removing the needle from the sheath while maintaining the sheath within the TAP and subsequently advancing the catheter through the sheath and into the pooled liquid in the TAP; 
 withdrawing the sheath while maintaining the catheter located within the TAP; and 
 with the catheter located in the TAP, connecting the catheter to a local anesthetic source for providing a defined volume of anesthetic to the catheter site in the TAP at a controlled delivery rate. 
   
     
     
         2 . The procedure as in  claim 9 , further comprising advancing the sheath distally away from the needle and further into the liquid pool in the TAP prior to or in conjunction with removing the needle from the sheath. 
     
     
         3 . The procedure as in  claim 9 , wherein the fluid delivery needle is an epidural needle, and further comprising connecting the epidural needle to an extension tube also provided in the kit, wherein the local anesthetic or saline/anesthetic combination is injected through the epidural needle and tubing with a syringe also provided in the kit. 
     
     
         4 . The procedure as in  claim 9 , wherein the sheath is echogenic so that placement of the sheath into the TAP is also visible with the ultrasonic probe. 
     
     
         5 . The procedure as in claim  12 , wherein the sheath is rendered echogenic by a plurality of holes through the sheath along an axial length thereof. 
     
     
         6 . The procedure as in claim  12 , wherein the sheath is rendered echogenic by surface modifications of the sheath with echogenic material. 
     
     
         7 . A procedure for performing an ultrasound-guided transversus abdominis plane (TAP) procedure, comprising:
 scanning a patient's abdomen with an ultrasound probe, and identifying and marking the external oblique, internal oblique, and TAP;   placing an introducer sheath over a fluid delivery needle such that the distal end of the needle extends beyond the distal end of the sheath, the needle having echogenic properties for ultrasound imaging;   ultrasonically guiding the needle and sheath into the TAP;   injecting a local anesthetic or saline/anesthetic combination through the needle and creating a liquid pool in the TAP;   removing the needle from the sheath while maintaining the sheath within the TAP and subsequently advancing a catheter through the sheath and into the pooled liquid in the TAP;   withdrawing the sheath while maintaining the catheter located within the TAP;   with the catheter located in the TAP, connecting the catheter to a local anesthetic source for providing a defined volume of anesthetic to the catheter site in the TAP at a controlled delivery rate; and   performing the procedure with a kit that includes the introducer sheath, fluid delivery needle, and catheter within a container.   
     
     
         8 . The procedure as in claim  15 , further comprising advancing the sheath distally away from the needle and further into the liquid pool in the TAP prior to or in conjunction with removing the needle from the sheath. 
     
     
         9 . The procedure as in claim  15 , wherein the needle is an epidural needle, and further comprising connecting the epidural needle to an extension tube also provided in the kit, wherein the local anesthetic or saline/anesthetic combination is injected through the needle and tubing with a syringe also provided in the kit. 
     
     
         10 . The procedure as in claim  15 , wherein the sheath is echogenic so that placement of the sheath into the TAP is also visible with the ultrasonic probe. 
     
     
         11 . The procedure as in claim  18 , wherein the sheath is echogenic from one of: holes defined through the sheath along an axial length thereof, surface modification with an echogenic material.