Design: Surgical education video. Our mandatory institutional consent form to use patient’s operative video for medical education purposes was obtained.

Setting: Tertiary referral academic center.

Patients or Participants: Our patient is a 45-year-old G5P3023 who underwent a scheduled total laparoscopic hysterectomy, bilateral salpingectomy, and cystoscopy for AUB-L refractory to medical management.

Interventions: Transverse abdominis plane block using a transdermal approach and a transperitoneal approach.

Measurements and Main Results: The goal of intra-operative TAP block is to provide anesthesia to the abdominal wall and numb the thoraco-abdominal nerves. We used a mixture of liposomal bupivacaine, regular bupivacaine, and normal saline. Using a transdermal approach, a small-bore needle is advanced to the peritoneum and retracted just behind the transverse abdominis muscles and injected so that a wheal can be observed in the transverse abdominis muscles. Using a transperitoneal approach, a laparoscopic needle is advanced through a lateral port and placed through the peritoneum to inject between the transverse abdominis muscles and internal oblique muscles to observe a wheal. In both approaches, we perform a series of injections along the lateral abdominal wall from the superior most port to the level of the inferior port or the iliac crest. The route of performing a TAP block is surgeon preference but may be influenced by equipment availability and patient characteristics such as BMI.

Conclusion: Surgeon-performed TAP block under laparoscopic guidance is a safe, efficient, and effective alternative to anesthesiologist-performed TAP block under ultrasound guidance.