MEDCOM – Paktia Regional Military Hospital WHO: PRMH Anesthesiology Department WHAT: PRMH Nerve Block Room WHERE : Paktia Regional Military Hospital, Paktia Province WHEN: 18 APR 2012 EFFECTS: The Transversus Abdominus Plane (TAP) block was taught to PRMH Medical Staff in a formal presentation on 4 APR 12. PRMH performs many lower abdominal surgeries each year. The TAP block reduces post operative pain up to 70%. The use of ultrasound to guide needle placement for the TAP block improves block success and is associated with fewer complications. Coordination between the Anesthesia Dept, Surgical Services Dept, Radiology Dept, and Nursing Services Dept facilitated cooperation in excellent patient care and excellent patient outcome. Photos: Maj Brooks Goettle USAF 18 APR 2012 NTM-A Gardez MED/ETT Gardez, Paktia Province, RC-E Top Left: Maj Goettle instructs anesthetist Zikrullah on the use of PAJUNK ultrasound needle use , remarking on the heightened echogenicity of this patented needle. Top Right: Dr Wali, Chief of Radiology, instructs anesthetist Zikrullah how to select the correct ultrasound probe for this ultrasound-guided procedure. Bottom Lt: Anesthetist Zikrullah begins needle insertion with ultrasound guidance. Center: PAJUNK ultrasound needle in perfect TAP block position (blue arrow) Bottom Right: anesthetist Zikrullah with pain free patient postop. Pt remained pain free for >28 hours. UNCLASSIFIED/FOUO

MEDCOM – Paktia Regional Military Hospital · Top Left: Maj Goettle instructs anesthetist Zikrullah on the use of PAJUNK ultrasound needle use , remarking on the heightened echogenicity

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MEDCOM – Paktia Regional Military Hospital

WHO: PRMH Anesthesiology Department WHAT: PRMH Nerve Block Room WHERE: Paktia Regional Military Hospital, Paktia Province WHEN: 18 APR 2012 EFFECTS: The Transversus Abdominus Plane (TAP) block was taught to PRMH Medical Staff in a formal presentation on 4 APR 12. PRMH performs many lower abdominal surgeries each year. The TAP block reduces post operative pain up to 70%. The use of ultrasound to guide needle placement for the TAP block improves block success and is associated with fewer complications. Coordination between the Anesthesia Dept, Surgical Services Dept, Radiology Dept, and Nursing Services Dept facilitated cooperation in excellent patient care and excellent patient outcome. Photos: Maj Brooks Goettle USAF

18 APR 2012 NTM-A Gardez MED/ETT Gardez, Paktia Province, RC-E

Top Left: Maj Goettle instructs anesthetist Zikrullah on the use of PAJUNK ultrasound needle use , remarking on the heightened echogenicity of this patented needle. Top Right: Dr Wali, Chief of Radiology, instructs anesthetist Zikrullah how to select the correct ultrasound probe for this ultrasound-guided procedure.

Bottom Lt: Anesthetist Zikrullah begins needle insertion with ultrasound guidance. Center: PAJUNK ultrasound needle in perfect TAP block position (blue arrow) Bottom Right: anesthetist Zikrullah with pain free patient postop. Pt remained pain free for >28 hours.

UNCLASSIFIED/FOUO