IINB, IHNB, TAP block

[Dr. Mian]

I have recently become interested in these as my group have decreased the number of epidurals we leave in because of anticoagulation, reimbursement, and followup issues.

I have done a handful with and without ultrasound guidance, with varying effectiveness.

Anybody have more experience with these?  Could you share some helpful pointers?

Most of the sources say that the goal is to inject between IO and TA, although some say that the nerves can penetrate IO laterally and lie between EO and IO.

I do not have access to blunt needles so the so-called "double pop" technique is not much of an option; instead when performing the block blind I use a 25 g 1.5 inch needle which I doubt reaches the TA plane in my obese patient population (TX, USA).

Any thoughts?