Continuous Transversus Abdominis Plane Block

• US 20110201930A1
• Filed: 02/11/2011
• Published: 08/18/2011
• Est. Priority Date: 02/12/2010
• Status: Active Grant

• Current Assignee: Avent Incorporated (Avanos Medical, Inc.)
• Original Assignee: Kimberly-Clark Worldwide Incorporated (Kimberly-Clark Corporation)
• Inventors: Guzman, Michael F.
• Granted Patent: US 8,882,673 B2
• Time in Patent Office: Days
• US Class Current: 600/439
• CPC Class Codes: A61B 17/3401 Puncturing needles for the peridural or subarachnoid space or the plexus, e.g. for anaesthesia local anaesthesia A61M19/00
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 17/3415 for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters A61B17/3417 takes precedence; body piercing catheter guide needles A61M25/06
• CPC Class Codes: A61B 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• CPC Class Codes: A61B 2017/3413 guided by ultrasound
• CPC Class Codes: A61B 2034/2063 Acoustic tracking systems, e.g. using ultrasound
• CPC Class Codes: A61B 2046/205 Adhesive drapes
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 46/00 Surgical drapes
• CPC Class Codes: A61B 46/20 specially adapted for patients
• CPC Class Codes: A61B 8/0841 for locating instruments
• CPC Class Codes: A61M 19/00 Local anaesthesia syringes therefor A61M5/00; Hypothermia A61M5/42 takes precedence; cooling blood in a bypass of the arterial system A61M1/36
• CPC Class Codes: A61M 2025/0681 Systems with catheter and outer tubing, e.g. sheath, sleeve or guide tube
• CPC Class Codes: A61M 2202/048 Anaesthetics
• CPC Class Codes: A61M 2210/10 Trunk
• CPC Class Codes: A61M 2210/1021 Abdominal cavity
• CPC Class Codes: A61M 25/0662 Guide tubes
• CPC Class Codes: A61M 5/178 Syringes

Abstract

A procedure and kit are provided for performing an ultrasound-guided transversus abdominis plane (TAP) procedure. The patient'"'"'s abdomen is scanned with an ultrasound probe to identify and mark the external oblique, internal oblique, and TAP. An introducer sheath is placed 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. The needle and sheath are ultrasonically guided into the TAP. A local anesthetic or saline/anesthetic combination is injected through the needle to create a liquid pool in the TAP. The needle is removed from the sheath while maintaining the sheath within the TAP and a catheter is subsequently advanced through the sheath and into the pooled liquid in the TAP. The sheath is withdrawn while maintaining the catheter located within the TAP. A catheter is connected to a source of local anesthetic for providing a defined volume of anesthetic to the catheter site at a controlled delivery rate.

Claims

1. A procedure for performing an ultrasound-guided transversus abdominis plane (TAP) procedure, comprising:

scanning the 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; and

connecting the catheter to a local anesthetic source for providing a defined volume of anesthetic to the catheter site at a controlled delivery rate.

2. The procedure as in claim 1, 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 1, wherein the needle is an epidural needle, and further comprising connecting the epidural needle to an extension tube, wherein the local anesthetic or saline/anesthetic combination is injected through the needle and tubing with a syringe.

4. The procedure as in claim 1, further comprising rendering the sheath echogenic so that placement of the sheath into the TAP is also visible with the ultrasonic probe.

5. The procedure as in claim 4, wherein the sheath is rendered echogenic by defining holes through the sheath along the axial length thereof.

6. The procedure as in claim 4, wherein the sheath is rendered echogenic by surface modification of sheath with echogenic material.

7. The procedure as in claim 1, wherein the catheter is connected to a reservoir of local anesthetic having a defined fill volume and flow rate.

8. A medical procedure kit for performing an ultrasound-guided transversus abdominis plane (TAP) procedure, said kit comprising:

a container, said container further comprising;

a fluid delivery needle having a length and gauge for penetration into a patient'"'"'s TAP;

an extension set having a distal end that mates with said fluid delivery needle;

a sheath having a size and length such that said needle slides into said sheath and extends distally beyond a distal end of said sheath; and

a TAP catheter having a size and length so as to slide through said sheath, said TAP catheter comprising a reservoir having a defined fill volume and flow rate for delivery of a local anesthetic through said catheter.

9. The medical procedure kit as in claim 8, further comprising a local anesthesia and at least one syringe that mates with a proximal end of said extension set to delivery said local anesthesia through said needle.

10. The medical procedure kit as in claim 8, further comprising any combination of drape, dressings, or tape.

11. The medical procedure kit as in claim 8, wherein said extension set comprising an extension tube and a 90-degree adapter that mates with said needle.

12. The medical procedure kit as in claim 8, wherein said needle is a fixed wing Weiss epidural needle with a Tuohy point.

13. The medical procedure kit as in claim 8, wherein said container comprises a sealed tray.

14. The medical procedure kit as in claim 8, wherein said sheath comprises a proximal handle and a semi-rigid, echogenic section having a length so as to extend into the patient'"'"'s TAP subsequent to removal of said needle from said sheath.

15. The medical procedure kit as in claim 14, wherein said sheath is rendered echogenic by a plurality of perforations defined along said echogenic section.