alternativ:
Blockade der Transversus abdominis-Ebene

see also pictures in this link

The transversus abdominis plane (TAP) block was first described as a landmark-guided technique involving needle insertion at the triangle of Petit.1,2 This is an area bounded by the latissimus dorsi muscle posteriorly, the external oblique muscle anteriorly and the iliac crest inferiorly (the base of the triangle). A needle is inserted perpendicular to all planes, looking for a tactile endpoint of two pops. The first pop indicates penetration of the external oblique fascia and entry into the plane between external and internal oblique muscles; the second pop signifies entry into the TAP plane between internal oblique and transversus abdominis muscles. It has been shown to provide good postoperative analgesia for a variety of procedures.3-5

BLOCK TECHNIQUE
Scanning Technique
The ultrasound guided TAP block is considered a BASIC skill level block. It is relatively simple to identify the fascial plane between the internal oblique and transversus abdominis muscles.
The patient is placed in a supine position and the abdomen is exposed between the costal margin and the iliac crest.
A linear, high-frequency transducer is recommended for this block, as the relevant anatomical structures are relatively shallow.
Following skin and transducer preparation, the transducer is placed in an axial (transverse) plane, above the iliac crest, and in the region of the anterior axillary line.
The terminal branches of the anterior rami of T7 to L1 cannot be visualized but are expected to lie within the TAP between internal oblique and the transverse abdominis muscles above the iliac crest.
Identify the three muscular layers of the abdominal wall: the external oblique (most superficial), the internal oblique and transversus abdominis muscles (Figure 2). Among the three muscles, the internal oblique muscle is usually the most prominent layer. In the lower medial aspect of the abdominal wall, the external oblique muscle gives way to the external oblique aponeurosis and may therefore appear as a layer of fascia instead of muscle.
The peritoneal cavity lies deep to the transversus abdominis muscle layer and may be identified by the peristaltic movements of bowel loops.

http://www.usra.ca/sb_tap



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Note added at 49 mins (2009-11-03 17:58:02 GMT)
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aber auch TAP-Block im Deutschen
Auch die Rektusscheidenblockade (23) und der TAP-Block (24;25)
sind letztlich nur mit Ultraschall zuverlässig und risikoarm durchzuführen.
http://www.kindernarkose.ch/OLD/KATZ09/referenten1-Dateien/D...