Abdominal Wall Blocks: Safe Practice and Management of Adverse Events


Key Points

  • Abdominal wall blocks have gained popularity in recent years as an alternative to epidural anesthesia. Due to the vascularity of the target area, the risk of local anesthetic toxicity is heightened.

  • The key to safe abdominal wall blockade is anatomical knowledge, ultrasound scanning skill, and adherence to local anesthetic dose limits.

  • Although rare, trauma to the abdominal wall itself and intra-abdominal structures has been reported. Another rare complication that should be considered is inadvertent femoral nerve block.

  • Absorption of local anesthetic following TAP block is rapid and, although peak plasma concentrations are comparable to other blocks, several reports of seizures have been published, usually following injection of large local anesthetic doses.

  • Abdominal blocks can be challenging in certain populations, including children, the obese, pregnant women, and individuals with coagulopathy. Awareness of needle size and trajectory and local anesthetic dosing are especially critical to avoiding complications in these patients.


Anesthetic techniques Regional Abdominal wall Rectus Abdominis muscle Toxicity Local anesthetics Management 



Anterior Superior Iliac Spine


Median effective dose


Local anesthetic


Transversus abdominis plane


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Anesthesia and PharmacologyUniversity of Melbourne, Royal Women’s HospitalParkvilleAustralia
  2. 2.Northeast Health Wangaratta, University of MelbourneMelbourneAustralia

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