Anatomical topography of the inferior lumbar triangle for transversus abdominis block
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Rapid development of anesthetic techniques of thoracic paravertebral block required to redefine anatomical landmarks of the inferior lumbar (Petit) triangle (ILT). Anesthesiologists are mainly interested in the ILT to perform the transversus abdominis plane (TAP) block. The aim of this study was to provide comprehensive information of the ILT to improve the success of TAP block.
Descriptional anatomy of ILTs such as dimensions, space, area, and types was analyzed in 25 preserved adult male cadavers.
The ILT was identified in 100% out of all explored cadavers’ lumbar regions. The predominant triangle was the acute-angled shaped (46%). The ILT in terms of the surface area was classified into four distinct types: Type I with a surface area <8 cm2 was identified in 50%. Type II or intermediate triangles with a surface area of 8–12 cm2 were detected in 36%. Type III or large triangles with a surface area >12 cm2 were found in 14%. Type 0 or no triangle did not exhibit a triangle. For the orientation zone over the posterior lumbar region, it was measured with the distances from the posterior median line (M) to the apex (A), medial point (B), and lateral point (C) of the triangle. MA; as M1A transverse line: 103.3 ± 21.3 mm (left) and 106.4 ± 18.4 mm (right), MB; as M2B transverse line; 102.4 ± 21.8 mm (left) and 105 ± 17.9 mm (right), MC; as M3C transverse line; 119 ± 20.5 mm (left) and 120 ± 19.2 mm (right) were measured. In addition, the measurements of the vertical lines were measured. M1A–M2B and M1A–M3C vertical lines were 20.1–22.8 mm (left–right) and 30–29 mm (left–right), respectively.
The shape, the size, useful points, geometry, and topography of the ILT are important to determine the orientation points during block procedures. It is possible to visualize the needle pathway in different shape of ILT to ultrasound-guided TAP block. Anesthetic intervention needs to be individualized, depending upon the size of the triangle. The findings may be useful in establishing the area with the highest probability of localization of the ILT which can improve both the safety and efficiency of TAP block.
KeywordsInferior lumbar triangle Petit Transverse abdominis plane block
HB: data collection and provision of materials. YP: conception and design, provision of materials, and literature search. FG: conception and design, writing the article, statistical expertise, and literature search. GNC: data collection.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study complies with the current laws of the country in which it was performed. This study was approved by the ethics committee of Ege University (Approval date and number: 27 March 2012–12-4/6). We declare that this human study have been approved by the ethics committee of Ege University and have, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
We declare that all patients gave informed consent prior to inclusion in this study. We declare that this manuscript does not contain clinical studies or patient data.
- 8.Desmet M, Helsloot D, Vereecke E, Missant C, van de Velde M (2015) Pneumoperitoneum does not influence spread of local anesthetics in midaxillary approach transversus abdominis plane block: a descriptive cadaver study. Reg Anesth Pain Med 40(4):349–354. doi: 10.1097/AAP.0000000000000260 CrossRefPubMedGoogle Scholar
- 22.Paraskeuopoulos T, Saranteas T, Kouladouros K, Krepi H, Nakou M, Kostopanagiotou G, Anagnostopoulou S (2010) Thoracic paravertebral spread using two different ultrasound-guided intercostal injection techniques in human cadavers. Clin Anat 23(7):840–847. doi: 10.1002/ca.21021 CrossRefPubMedGoogle Scholar
- 26.Singh S, Dhir S, Marmai K, Rehou S, Silva M, Bradbury C (2013) Efficacy of ultrasound-guided transversus abdominis plane blocks for post-cesarean delivery analgesia: a double-blind, dose-comparison, placebo-controlled randomized trial. Int J Obstet Anesth 22(3):188–193. doi: 10.1016/j.ijoa.2013.03.003 CrossRefPubMedGoogle Scholar
- 27.Standring S, Borley NR, Collins P, Crossman AR, Gatzoulis MA, Healy JC, Johnson D, Mahadevan V, Newell RLM, Wigley CB (eds) (2008) Gray’s anatomy, 40th edn. Churchill Livingstone, London, p 346Google Scholar
- 28.Støving K, Rothe C, Rosenstock CV, Aasvang EK, Lundstrøm LH, Lange KH (2015) Cutaneous sensory block area, muscle-relaxing effect, and block duration of the transversus abdominis plane block: a randomized, blinded, and placebo-controlled study in healthy volunteers. Reg Anesth Pain Med 40(4):355–362CrossRefPubMedGoogle Scholar
- 29.Tan TT, Teoh WH, Woo DC, Ocampo CE, Shah MK, Sia AT (2012) A randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia. Eur J Anaesthesiol 29(2):88–94. doi: 10.1097/EJA.0b013e32834f015f CrossRefPubMedGoogle Scholar