Welcome to another talk in André Boezaart’s series on the

static sonoanatomy for regional anesthesia and acute pain

medicine. With this talk, we will discuss the sonoanatomy of

abdominal wall and the transversus abdominis plane (TAP).

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The authors are André Boezaart, a professor of anesthesiology and

orthopaedic surgery at the University of Florida, Division of Acute and

Perioperative Pain Medicine.

And

Barys V. Ihnatsenka, an assistant professor of anesthesiology at the

University of Florida, Division of Acute and Perioperative Pain

Medicine.

The reader is strongly encouraged to systematically duplicate every

one of these images on a model while studying the sonoanatomy and

also to view the movie that covers the dynamic sonoanatomy of this

area.

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The  ultrasound  probe  that  was  used  was  a  6-­‐  to  13-­‐MHz  linear  probe  

with  a  38-­‐mm  footprint  (HFL–38,  SonoSite  Fujifilm,  Bothell,  WA,  USA).    

Ultrasound  is  a  dynamic  process  whereby  structures  can  and  should  be  

followed  to  their  origins  and  desNnaNons  for  opNmal  idenNficaNon.  It  is  

therefore  not  always  saNsfactory  to  study  staNc  ultrasound  images.    

When  studying  the  sonoanatomy  of  the  abdominal  wall,  the  authors  

strongly  advise  readers  to  study  the  macroanatomy  first  and  then  to  view  

the  accompanying  video  that  illustrates  the  dynamic  sonoanatomy  of  the  

abdominal  wall  and  transversus  abdominis  space.      

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Abdominal  wall  muscles  and  nerves.    

The  transversus  abdominis  plane  (TAP)  is  between  numbers  2  

and  4.  

 

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Anterior  transversus  abdominis  plane  (the  model’s  head  is  on  

the  leS  side  of  picture).  

Anterior,  between  the  iliac  crest  and  the  rib  cage,  there  are  

three  abdominal  muscles.  From  superficial  to  deep,  they  are  the  

external  oblique,  internal  oblique,  and  transversus  abdominis  

muscles.  The  TAP  is  the  fascia  layer  between  the  laDer  two.  An  

anterior  TAP  block  splits  this  layer  to  block  the  nerves  situated  

here.  

 

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 Posterior  transversus  abdominis  plane  (the  model’s  head  is  on  

the  leS  side  of  picture).  

Ant  =  anterior;  Post  =  posterior;  TAP  =  transversus  abdominis  

plane.  

The  transversus  abdominis  muscle  becomes  aponeuroHc  

posterior.  Note  the  TAP  again  between  the  internal  oblique  and  

transversus  abdominis  muscles.  Also  note  the  extraperitoneal  

adipose  Hssue  and  the  transversalis  fascia  deep  to  the  

transversus  abdominis  muscle  and  the  bowel  deep  to  these  

structures.    

 

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Subcostal  transversus  abdominis  plane  (the  model’s  head  is  on  

the  leS  side  of  the  picture).  

Ant  =  anterior;  Post  =  posterior;  TAP  =  transversus  abdominis  

plane  

The  tendons  of  all  three  abdominal  muscles  merge  to  form  the  

anterior  and  posterior  rectus  sheath,  which  hosts  the  rectus  

abdominis  muscle.  Note  the  presence  of  the  liver  deep  to  the  

transversus  abdominis  muscle.  Above  the  arcuate  line  (see  text),  

the  rectus  sheath  consists  of  the  merged  tendons  of  the  

abdominal  muscles.  Below  this  line,  it  consists  of  the    

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Ilioinguinal  and  iliohypogastric  nerves  (the  model’s  head  is  

now  on  the  right  side  of  the  picture).  

 LCNT  =  lateral  cutaneous  nerve  of  the  thigh.  

Note  the  angle  of  the  ultrasound  probe.  The  abdominal  muscles  

implant  on  the  iliac  crest,  and  the  presence  of  the  ilioinguinal  

and  iliohypogastric  nerve,  arteries,  and  veins  are  situated  in  the  

fascia  layer  between  the  internal  oblique  and  transversus  

abdominis  muscles.  The  lateral  cutaneous  nerve  of  the  thigh  is  

on  the  anterior  border  of  the  iliacus  muscle,  which  can  be  seen  

anterolateral  to  the  iliac  crest.    

 

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Thank you for your attention and we look forward to seeing

you again soon in another talk by André Boezaart in this

series on static sonoanatomy for regional anesthesia and

acute pain medicine topics.  

Please be sure to view and listen to the lecture series on the

Must-Know Anatomy for Regional Anesthesia and Acute Pain

Medicine, and watch the movies on all the Dynamic

Sonoanatomy for RA & APM.

All material is protected by copyright to RAEducation.com

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This lecture series was adapted from:

“The Anatomical Foundations of Regional Anesthesia and

Acute Pain Medicine: Macroanatomy, Microanatomy,

Sonoanatomy and Functional Anatomy”

By: André P. Boezaart

Illustrated by: Mary K. Bryson

Published by: Bentham Science (eBooks)

(http://ebooks.benthamscience.com/index.php)

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Other lectures in this series on static sonoanatomy:

1.  Sonoanatomy of the posterior triangle of the neck

2.  Sonoanatomy of the infraclavicular area

3.  Sonoanatomy of the nerves in the axilla and around the

elbow and wrist

4.  Sonoanatomy of the nerves in the anterior upper thigh

5.  Sonoanatomy of the sciatic nerve

6.  Sonoanatomy of the abdominal wall and TAP

7.  Sonoanatomy of the thoracic paravertebral space

Also please see other lecture series (Visit RAEducation.com):

1.  Dynamic sonoanatomy movie lecture series (14 movies)

2.  Must-know anatomy for RA and APM series (18 lectures)

3.  Controversial issues in RA & APM series (12+ lectures)

4.  High yield continuous nerve blocks movie series (5+

movies)

5.  Vintage block movies (Moore) (6 movies)

6.  Block movies pre-ultrasound (Boezaart) (16 movies)

7.  Functional anatomy movie series (percutaneous nerve

stimulation on painted model) (17 movies)

8.  Bigeleisen sagittal section movies (2 movies)

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