U.S. patent application number 15/445013 was filed with the patent office on 2017-06-15 for continuous transversus abdominis plane block.
The applicant listed for this patent is Avent, Inc.. Invention is credited to Michael F. Guzman.
Application Number | 20170165450 15/445013 |
Document ID | / |
Family ID | 44370129 |
Filed Date | 2017-06-15 |
United States Patent
Application |
20170165450 |
Kind Code |
A1 |
Guzman; Michael F. |
June 15, 2017 |
Continuous Transversus Abdominis Plane Block
Abstract
A kit is provided for performing an ultrasound-guided
transversus abdominis plane (TAP) procedure. The kit includes a
container having a fluid delivery needle with a length and gauge
for penetration into a patient's TAP. An extension set is included
having a distal end that mates with the fluid delivery needle. A
sheath is included having a size and length such that the needle
slides into sheath and extends distally beyond a distal end of the
sheath. A TAP catheter is included having a size and length so as
to slide through the sheath. The TAP catheter has a reservoir with
a defined fill volume and flow rate for delivery of a local
anesthetic through said catheter.
Inventors: |
Guzman; Michael F.;
(Fortville, IN) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Avent, Inc. |
Alpharetta |
GA |
US |
|
|
Family ID: |
44370129 |
Appl. No.: |
15/445013 |
Filed: |
February 28, 2017 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
14538333 |
Nov 11, 2014 |
|
|
|
15445013 |
|
|
|
|
13025448 |
Feb 11, 2011 |
8882673 |
|
|
14538333 |
|
|
|
|
61303766 |
Feb 12, 2010 |
|
|
|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61M 2210/1021 20130101;
A61B 46/20 20160201; A61B 8/0841 20130101; A61B 2034/2063 20160201;
A61M 25/0662 20130101; A61B 2046/205 20160201; A61B 2017/3413
20130101; A61M 2025/0681 20130101; A61M 5/178 20130101; A61M
2210/10 20130101; A61B 17/3468 20130101; A61M 2202/048 20130101;
A61B 17/3415 20130101; A61B 34/20 20160201; A61B 17/3401 20130101;
A61M 19/00 20130101; A61B 17/3403 20130101; A61B 46/00
20160201 |
International
Class: |
A61M 19/00 20060101
A61M019/00; A61B 46/20 20060101 A61B046/20; A61M 25/06 20060101
A61M025/06; A61B 17/34 20060101 A61B017/34 |
Claims
1. A procedure for performing an ultrasound-guided transversus
abdominis plane (TAP) procedure with a kit, wherein the kit
includes: a container; a fluid delivery needle provided in the
container and having a length and gauge for penetration into a
patient's TAP, the fluid delivery needle having a tissue piercing
distal tip configured for push-advancement into a TAP plane of a
patient and direct delivery of a fluid through the needle to create
a liquid pool in the TAP, the fluid delivery needle having a handle
at a proximal end thereof that extends radially outward from an
axis of the fluid delivery needle; an extension set provided in the
container and having a distal end that mates with the fluid
delivery needle; a sheath provided in the container and formed of a
flexible material so as to conform to the patient's TAP, the sheath
having a handle at a proximal end thereof and a size and length
such that the needle slides into the sheath and extends distally
beyond a distal end of the sheath as the needle and sheath are
advanced together into the TAP with the needle handle engaged
against the sheath handle, the sheath handle extending outward from
an axis of the sheath radially beyond the needle handle; a catheter
having a size and length so as to slide through the sheath, the TAP
catheter having a reservoir with a defined fill volume and flow
rate for delivery of a local anesthetic through the catheter; the
procedure further comprising: scanning a patient's abdomen with an
ultrasound probe, and identifying and marking the external oblique,
internal oblique, and TAP; placing the introducer sheath over the
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
the catheter through the sheath and into the pooled liquid in the
TAP; withdrawing the sheath while maintaining the catheter located
within the TAP; and with the catheter located in the TAP,
connecting the catheter to a local anesthetic source for providing
a defined volume of anesthetic to the catheter site in the TAP at a
controlled delivery rate.
2. The procedure as in claim 9, 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 9, wherein the fluid delivery needle
is an epidural needle, and further comprising connecting the
epidural needle to an extension tube also provided in the kit,
wherein the local anesthetic or saline/anesthetic combination is
injected through the epidural needle and tubing with a syringe also
provided in the kit.
4. The procedure as in claim 9, wherein the sheath is echogenic so
that placement of the sheath into the TAP is also visible with the
ultrasonic probe.
5. The procedure as in claim 12, wherein the sheath is rendered
echogenic by a plurality of holes through the sheath along an axial
length thereof.
6. The procedure as in claim 12, wherein the sheath is rendered
echogenic by surface modifications of the sheath with echogenic
material.
7. A procedure for performing an ultrasound-guided transversus
abdominis plane (TAP) procedure, comprising: scanning a 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; with the catheter located in the TAP,
connecting the catheter to a local anesthetic source for providing
a defined volume of anesthetic to the catheter site in the TAP at a
controlled delivery rate; and performing the procedure with a kit
that includes the introducer sheath, fluid delivery needle, and
catheter within a container.
8. The procedure as in claim 15, 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.
9. The procedure as in claim 15, wherein the needle is an epidural
needle, and further comprising connecting the epidural needle to an
extension tube also provided in the kit, wherein the local
anesthetic or saline/anesthetic combination is injected through the
needle and tubing with a syringe also provided in the kit.
10. The procedure as in claim 15, wherein the sheath is echogenic
so that placement of the sheath into the TAP is also visible with
the ultrasonic probe.
11. The procedure as in claim 18, wherein the sheath is echogenic
from one of: holes defined through the sheath along an axial length
thereof, surface modification with an echogenic material.
Description
RELATED APPLICATIONS
[0001] The present application is a Continuation Application of
U.S. Divisional application Ser. No. 14/538,333 filed Nov. 11,
2014, which is a Divisional of application Ser. No. 13/025,448
filed Feb. 11, 2011, and issued as U.S. Pat. No. 8,882,672, which
claims priority to U.S. Provisional Application Ser. No. 61/303,766
filed on Feb. 12, 2010, entitled "Continuous Transversus Abdominis
Plane Block," which is incorporated herein by reference in its
entirety for all purposes.
FIELD OF THE INVENTION
[0002] The present invention relates generally to the field of
medical abdominal field blocks, and more particularly to methods
and devices for performance of transversus abdominis plane (TAP)
blocks.
BACKGROUND
[0003] The use of abdominal field blocks is well known for
relieving pain experienced by patients after abdominal surgery.
Conventional blocks, however, provide limited analgesic fields and,
thus, multiple blind injections were usually required, with the
success of such injections being unpredictable.
[0004] Transversus abdominis plane (TAP) blocks are a fairly
recently developed single entry point procedure that accesses a
number of the abdominal wall nerves, thereby providing a more
widespread analgesic effect. The goal of a TAP block is to deposit
local anesthetic in the plane between the internal oblique and
transversus abdominis muscles to target the spinal nerves in this
plane. The block is typically preformed blind, with the point of
entry for the blind tap being the patient's triangle of Petit
situated between the lower costal margin and the iliac crest and
bound anteriorly by the external oblique muscle and posteriorly by
the latissimus dorsi. The blind technique relies on the
practitioner feeling double "pops" as the needle traverses the
external oblique and internal oblique muscles.
[0005] Ultrasound-guided TAP blocks are gaining acceptance for
providing better localization and injection of the local anesthetic
with improved accuracy. With the ultrasound procedure, an
ultrasound probe is placed in a plane essentially transverse to the
lateral abdominal wall between the lower costal margin and the
iliac crest. Ultrasonic imaging allows for a more accurate
deposition of the local anesthetic in the correct neurovascular
plane. Ultrasound-guided TAPS are indicated for essentially any
lower abdominal surgery, including appendectomy, hernia repair,
caesarean section, abdominal hysterectomy, and prostatectomy.
Effectiveness has also been shown in laparoscopic surgery.
[0006] The present invention provides further advancements in the
methodology and devices for ultrasound TAP procedures.
SUMMARY OF THE INVENTION
[0007] Objects and advantages of the invention will be set forth in
part in the following description, or may be obvious from the
description, or may be learned through practice of the
invention.
[0008] In accordance with various aspects, a medical procedure is
provided for performing an ultrasound-guided transversus abdominis
plane (TAP) procedure. After prepping, the patient's abdomen is
scanned with any suitable ultrasound probe, and the external
oblique, internal oblique, and TAP are identified and marked. An
introducer sheath is placed over a fluid delivery needle, such as
an epidural needle, such that the distal end region of the needle
extends beyond the distal end of the sheath. The needle is an
echogenic device in that it is readily "detected" by the probe
during ultrasound imaging. The ultrasound probe may be used
throughout the procedure to relocate or confirm location of the TAP
and various instruments within the TAP.
[0009] While ultrasonically imaging the site, the needle and sheath
are advanced into the TAP and a liquid pool is created in the TAP
by injecting a local anesthetic or saline/anesthetic combination
through the needle. The needle is then removed from the sheath
while maintaining the sheath within the TAP. A catheter is then
slid through the sheath and into the pooled liquid in the TAP.
Correct sheath placement may be verified by backflow of the liquid
through the catheter as the catheter is extended beyond the sheath
and into the liquid pool.
[0010] Once the catheter has been positioned, the sheath is
withdrawn (e.g. by being slid proximally over the catheter) while
maintaining the catheter stationary within the TAP. The catheter
site may then be dressed and a reservoir of a local anesthetic
connected to the proximal end of the catheter and configured for
providing a defined volume of the anesthetic to the catheter site
at a controlled delivery rate.
[0011] In a particular embodiment, the sheath may be advanced
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. The sheath may be advanced until a slight resistance is
felt by the practitioner (indicating that the sheath has reached
the boundary of the liquid pool in the TAP).
[0012] The needle may be a Weiss epidural needle having fixed
wings, which is connected to an extension set. A syringe may be
used to inject the local anesthetic or saline/anesthetic through
the extension set and needle to generate the liquid pool within the
TAP. The extension set may be a simple tube that connects between
the needle and syringe, or may include any manner of adapter, such
as a 90-degree adapter, for enabling the procedure.
[0013] The distal portion of the needle that extends beyond the
sheath is echogenic and thus readily visible during the ultrasound
guidance of the needle and sheath into the TAP. It may, however, be
desirable to also render the sheath echogenic to aid in the
guidance procedure and to ultrasonically verify placement of the
sheath after removal of the needle. In this regard, the sheath may
contain any manner echogenic material, such as metal threads or
flakes, formed with the sheath or subsequently added to the surface
of the sheath. In another embodiment, the sheath may be rendered
effectively echogenic by simply defining holes or perforations
through the sheath such that that the metal needle is exposed
through the perforations during the ultrasonically imaging. By
detecting axial points or sections of the needle through the
sheath, the location of the sheath is also verified.
[0014] In other aspects, the present invention encompasses any
manner of medical procedure kit for performing an ultrasound-guided
TAP procedure, as described above. In a particular embodiment, this
kit may include a container, for example a tray having a
sealed/removable covering. The components within the tray for
performing the procedure may include a fluid delivery needle having
a length and gauge for penetration into a patient's TAP. This
needle may be, for example, a fixed-wing Weiss epidural needle. A
sheath is included for operational configuration with the needle,
as discussed above. The sheath has a size and length such that the
needle slides into the sheath and extends distally beyond the
distal end of the sheath. The sheath may include 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 the needle from the
sheath. The sheath may be rendered echogenic by inclusion of an
echogenic material or a plurality of perforations defined along the
axial length of the echogenic section.
[0015] An extension set may also be included in the kit, and may be
variably configured with any manner of tubing, adapters, and the
like. The extension set has a distal end that mates with the fluid
delivery needle. A sheath is included having a size and length such
that the needle slides into the sheath and extends distally beyond
a distal end of the sheath.
[0016] A TAP catheter may be included in the kit having a size and
length so as to slide through sheath and into the patient's TAP.
The TAP catheter has a reservoir with a defined fill volume and
delivery flow rate for controlled delivery of a local anesthetic to
the catheter site.
[0017] The kit may include any manner or number of additional items
for enabling the procedure. For example, the kit may include one or
more vials of local anesthesia, saline, or a mix of anesthesia and
saline, as well as a syringe that mates with a proximal end of the
extension set to deliver the local anesthesia/saline through the
needle to create the liquid pool in the TAP. Similarly, the kit may
include any combination of drape, catheter site dressings, tape,
and so forth.
BRIEF DESCRIPTION OF THE DRAWINGS
[0018] FIG. 1 is an illustration of regions of a human abdomen;
[0019] FIG. 2 is an ultrasound image of the muscular layers of the
anterolateral abdominal wall;
[0020] FIGS. 3A through 3H are depictions of various components and
items that may be used in performance of an ultrasonically-guided
TAP block procedure in accordance with aspects of the
invention;
[0021] FIG. 4 depicts an assembly of various components of FIGS. 3A
through 3H as a kit;
[0022] FIG. 5A is a perspective view of step of a step of an
ultrasonically-guided TAP block procedure in accordance with
aspects of the invention;
[0023] FIG. 5B is an ultrasonic image with a depiction of a needle
and sheath within the TAP resulting from the step of FIG. 5A;
[0024] FIG. 6A is a perspective view of an additional step of the
ultrasonically-guided TAP block procedure; FIG. 6B is an ultrasonic
image with a depiction of the sheath within the TAP resulting from
the step of FIG. 6A;
[0025] FIG. 7A is a perspective view of another step of the
ultrasonically-guided TAP block procedure;
[0026] FIG. 7B is an ultrasonic image with a depiction of catheter
and sheath within the TAP resulting form the step of FIG. 7A;
[0027] FIG. 8A is a perspective view of still another step of the
ultrasonically-guided TAP block procedure; and
[0028] FIG. 8B is an ultrasonic image with a depiction of a
continuous delivery catheter within the TAP.
DETAILED DESCRIPTION OF THE INVENTION
[0029] Reference will now be made in detail to one or more
embodiments of the invention, examples of the invention, examples
of which are illustrated in the drawings. Each example and
embodiment is provided by way of explanation of the invention, and
is not meant as a limitation of the invention. For example,
features illustrated or described as part of one embodiment may be
used with another embodiment to yield still a further embodiment.
It is intended that the invention include these and other
modifications and variations as coming within the scope and spirit
of the invention.
[0030] The anatomy view of FIG. 1 is provided for an appreciation
and understanding of a TAP block procedure. The anterior abdominal
wall (including the skin, muscles, parietal peritoneum) is
innervated by the anterior rami of the lower thoracic nerves and
the first lumbar nerve. Terminal branches of these somatic nerves
run through the lateral abdominal wall within a plane between the
internal oblique and transverse abdominis muscles. This
intermuscular plane is referred to as the transversus abdominis
plane (TAP). Referring to FIG. 1, a TAP procedure is performed at
the triangle of Petit, which is the area bounded posteriorly by the
latissimus dorsi, anteriorly by the external oblique muscle, and
inferiorly (base of the triangle) by the iliac crest. FIG. 2 is an
ultrasound image of the external oblique (EO), internal oblique
(IO), and transversus abdominis (TA) muscle layers. The procedure
involves insertion of a needle from a direction transverse to the
planes depicted in FIG. 2 through the EO, IO, and into the TAP
plane. This plane has been shown to provide good postoperative
analgesia for a variety of procedures.
[0031] FIGS. 3A through 3H depict various items and components that
may be used by a practitioner to practice the TAP procedure
described herein. It should be appreciated that the particular
articles depicted in the figures and described herein are not
limiting factors on practice of the present method, but are devices
that have proven to be useful and preferred.
[0032] FIG. 3A depicts an embodiment of a needle 24 for use in the
procedure, as discussed in greater detail below. The needle 24 may
include a handle at the proximal (away from the patient) and a
piercing tip at the distal end region 28. The needle 24 is
particularly configured for delivery of a fluid through an
injection site. A useful embodiment of a needle 24 is a Weiss
epidural needle. In particular, the needle 24 may be a Weiss
epidural needle supplied by Becton Dickinson (BD) having fixed
wings 26 and a modified Tuohy point. The needle may be a five-inch,
18 gauge needle and is identified by the BD product number 405190.
It should be appreciated, however, that other types of suitable
epidural needles may also be utilized.
[0033] FIG. 3B depicts an extension set 40 for configuration with
the proximal end of the needle 24. In a simple embodiment, the
extension set 40 may be an extension tube 42 having any desired
length, for example a thirty-inch extension tube. The extension set
40 may include any manner of additional components, such as a
90-degree adapter 44 that mates with the proximal end of the needle
24, with the tube 42 extending from the adapter 44 at a 90-degree
angle relative to the axis of the needle 24. An embodiment of such
an adapter is provided in a product commercially available from
Braun and identified as the "Contiplex Tuohy Continuous Nerve
Bblock Set" (product reference number 331691). A 30-inch extension
set is available from Hospira (product reference number
3229-03).
[0034] FIG. 3C depicts an embodiment of a sheath 14 having a handle
16 at a proximal end thereof. An extension 18 extends
perpendicularly from the handle 16 and terminates at a distal
(towards the patient) end 22. The sheath 14 has a size and length
such that the needle 24 extends through the sheath 14 with the
distal end region 28 of the needle 24 extending distally from the
end 22 of the sheath 14 when the components are configured together
and inserted into the TAP region of the patient. The sheath 14 may
be a generally semi-rigid or flexible member that has at least some
ability to conform within the TAP region, particularly within the
confines of the liquid pool generated in the TAP. A particularly
useful sheath 14 is available from IFLO as a component of the 2.5
inch Soaker Catheter (product reference number PM 010).
[0035] The extension 18 of the sheath 14 is generally composed of a
semi-rigid or flexible material, such as plastic, elastomeric, and
the like. Such materials are, however, inherently non-echogenic. In
this regard, it may be desired to render the extension portion 18
of the sheath 14 echogenic by, for example, forming the extension
18 with one or more echogenic elements integrated with the
extension 18. These elements may be, for example, a metallic thread
affixed to the outer surface of the extension portion 18 or
embedded within the extension portion 18. Metallic flakes may be
adhered or attached to the external surface of the extension
portion 18, or impregnated within the extension portion 18.
[0036] In a particularly unique embodiment, the extension portion
18 of the sheath 14 may be rendered echogenic by simply perforating
the extension portion 18 with a series of holes or other openings
along the axial length thereof. These holes or openings essentially
expose the needle 24 to ultrasonic imaging. Thus, portions or
sections of the needle disposed within the extension portion 18 are
visible in an ultrasonic imaging process, thereby essentially
rendering the sheath echogenic. Referring to FIG. 3C, perforations
20 are depicted along the axial length of the extension portion 18
of the sheath 14.
[0037] FIG. 3D represents any manner of suitable catheter site
dressing, which may be one or more Tegaderm.TM. products from
3M.
[0038] FIG. 3F depicts any manner of suitable syringe 46 that
connects with the proximal end of the extension set 40 to deliver a
local anesthetic or saline/anesthetic mixture through the extension
set 40 and needle 24.
[0039] FIG. 3E depicts any number of vials 48 of local anesthetic,
saline, or any other liquid that may be desired in performance of
the TAP procedure.
[0040] FIG. 3G is meant to depict any manner of drape 52 that is
uniquely configured for performance of the TAP procedure. For
example, the drape 52 may have any manner of fenestration located
within the drape 52 for access to the TAP procedure site. A
suitable drape is provided by Arrow as a clear 24.times.36 inch
fenestrated drape with a four-inch fenestration (with
adhesive).
[0041] FIG. 3G depicts a continuous flow catheter 30 that is
eventually deployed within the TAP region to provide a relatively
continuous flow of a local anesthetic from a reservoir 36, through
tubing 32, and eventually out through a delivery end 34. A suitable
continuous flow catheter 30 is provided by IFLO as the 2.5 inch
Soaker Catheter (product reference number PM010).
[0042] FIG. 4 is meant to depict a kit 56 that includes any manner
of suitable container 58 in which is provided any combination of
the components depicted in FIGS. 3A through 3H. The container 58
may be, for example, a suitable tray having a removable sealed
covering in which the articles are contained. It should be
appreciated that the kit 56 need not contain all of the articles
depicted in FIGS. 3A through 3H. For example, an embodiment of the
kit 56 may include the container 58 with a fluid delivery needle
24, extension set 40, sheath 14, and a continuous flow catheter 30,
as discussed above. Other embodiments of a kit 56 may include
additional items, such as the local anesthetic 48 (FIG. 3), syringe
46 (FIG. 3F), as well as any combination of drape 52 (FIG. 3G),
catheter site dressing 50 (FIG. 3D), and so forth. The invention
encompasses a kit 56 with any combination of the items of FIGS. 3A
through 3H.
[0043] FIGS. 5A through 8B depict various procedural steps of a TAP
block procedure in accordance with aspects of the invention. FIG.
5A depicts the abdominal region 10 of a patient that has been
prepped for the TAP procedure. Any manner of suitable ultrasonic
probe 12 is first used to identify and mark the external oblique
(EO), internal oblique (IO), and transversus abdominis (TA). The
epidural needle 24 has been inserted into the sheath 14 such that
the distal end region of the needle 24 extends beyond the distal
end of the sheath 14 (as depicted in FIG. 5A). While ultrasonically
imaging the procedure site, the needle 24 and sheath 14 are
advanced into the TAP and a liquid pool 54 (FIG. 5A) is created in
the TAP by injecting a local anesthetic or saline/anesthetic
combination through the needle 24 via a syringe and extension set
42, as discussed above. FIG. 5B depicts formation of the liquid
pool 54 in the TAP. It can be appreciated from FIG. 5B that the
distal end of the needle 24 is echogenic, and thus clearly
distinguishable in an ultrasonic imaging procedure. The extension
portion 18 of the sheath 14 has, in this particular embodiment, a
series of perforations such that sections of the needle 24 within
the extension section 18 are also visible in the ultrasonic imaging
procedure. Thus, placement of the sheath 14 is also verified by
referencing the position of the needle 24.
[0044] FIGS. 6A and 6B depict a subsequent step wherein the needle
24 is removed from sheath 14 while maintaining the extension
portion 18 of the sheath 14 within the liquid pool 54, as depicted
by the arrows in FIG. 6A. The ultrasonic probe 12 may be useful for
providing an image of removal of the needle 14. If the sheath 14
includes echogenic material, as discussed above, an ultrasonic
imaging technique may also be used to verify that the sheath 14 is
properly placed within the TAP, particularly within the liquid pool
54. With this step, it may also be desired to extend the sheath 14
further into the liquid pool 54, as depicted by the arrow in FIG.
6A, until a slight resistance is felt by the practitioner on the
extension section 18.
[0045] FIGS. 7A and 7B depict insertion of the catheter 30 through
the sheath 14. In particular, the delivery end 34 of the catheter
30 is inserted through the sheath and resides within the extension
portion 18 of the sheath 14 within the pool 54. During this
procedure, back flow of the liquid from the pool 54 through the
catheter 30 may be experienced, which is an indication of proper
placement of the sheath 14 within the liquid pool 54.
[0046] Referring to FIGS. 8A and 8B, once the delivery end 34 of
the catheter has been positioned within the pool 54, the sheath 14
is withdrawn from the TAP by being slid proximally over the
catheter tubing 42 while maintaining the delivery end 34 of the
catheter stationary within the liquid pool 54. The catheter site
may then be dressed with any suitable dressing, such as the
dressing 50 depicted in FIG. 3B. A reservoir of a local anesthetic
is connected to the proximal end of the tubing 32 and configured
for delivering a controlled flow rate of the local anesthetic over
a prolonged defined time period. The catheter 30, including the
reservoir 36, tubing 32, and the delivery end 34, may be configured
as a single integral unit, or independent components that are
subsequently connected together.
[0047] While the present invention has been described in connection
with certain preferred embodiments it is to be understood that the
subject matter encompassed by way of the present invention is not
to be limited to those specific embodiments. On the contrary, it is
intended for the subject matter of the invention to include all
alternatives, modifications and equivalents as can be included
within the spirit and scope of the following claims.
* * * * *