# TAP procedure for post op pain with continuous catheters



## savey (Feb 4, 2013)

Would like input re: coding for TAP procedure a) single and b) using a continuous catheter.  We have been using 64450-59 for the single and 64450-59-22 for the continuous catheters.  I have been advised that this is a common procedure in other areas of the country.  Our newly trained physicians have begun to use this rather frequently.

Thanks for your input.

Sandy


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## dwaldman (Feb 6, 2013)

What nerves are they documenting that being blocked with this block?


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## dwaldman (Feb 6, 2013)

http://www.nysora.com/peripheral_nerve_blocks/ultrasound-guided_techniques/3193-tap_block.html

The reason I ask is when I watched the above video of the block being performed I didn't see a specific other peripheral nerve they were targeting but looking at this other documents from the internet that describe nerve innervation but could this fall under an unlisted code:

TAP block involves deposition of local anaesthetic agent into the fascial plane superficial to the transversus abdominis muscle. This technique can be used for any surgery involving the lower abdominal wall, including bowel surgery, caesarean section, appendicectomy, hernia repair, umbilical surgery and gynaecological surgery. The relevant anatomy is described, followed by detailed descriptions of the landmark and ultrasound-guided techniques

Direct blockade of the neural afferent supply of the abdominal wall, such as abdominal field blocks, ilioinguinal, and hypogastric nerve blocks, have long been recognized as capable of providing significant postoperative analgesia in patients undergoing abdominal surgical procedures such as cesarean delivery (3) and inguinal herniorrhaphy (4). However, the lack of clearly defined anatomic landmarks has meant that the full potential of abdominal wall blockade in patients undergoing major abdominal procedures remains to be realized.

The skin, muscles, and parietal peritoneum of the anterior abdominal wall are innervated by the lower six thoracic nerves and the first lumbar nerve (2,5) (Fig. 1). The anterior primary rami of these nerves leave their respective intervertebral foramina and course over the vertebral transverse process. They then pierce the musculature of the lateral abdominal wall to course through a neuro-fascial plane between the internal oblique and transversus abdominis muscles. The sensory nerves branch first in the mid-axillary line sending out a lateral cutaneous branch, and continue within the plane to perforate anteriorly supplying the skin as far as the midline (2,5). The transversus abdominis plane thus provides a space into which local anesthetic can be deposited to achieve myocutaneous sensory blockade. Deposition of the local anesthetic dorsal to the mid-axillary line also blocks the lateral cutaneous afferents, thus facilitating blockade of the entire anterior abdominal wall (5). The lumbar triangle of Petit offers an easily identifiable, fixed and palpable landmark, and is located dorsal to the mid-axillary line (5). The transversus abdominis neuro-fascial plane can easily be accessed via this triangle, and local anesthetic deposited into this plane, using the loss of resistance technique as we have described. 

In this randomized, double-blind clinical trial, the TAP block produced effective and prolonged postoperative analgesia, when compared with standard therapy, in patients undergoing surgery via a midline abdominal wall incision. The TAP block reduced postoperative pain scores, both at rest and on movement, and reduced postoperative opioid requirements. Overall, during the first 24 postoperative hours, the TAP block reduced mean IV morphine requirements by more than 70%. This reduction in opioid requirement resulted in fewer opioid-mediated side effects. The incidence of PONV was reduced by more than half (69% vs 31%) in the TAP block group. Sedation scores were also modestly reduced in the patients who underwent TAP blockade.


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