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THE INNERVATION OF THE THORACO-ABDOMINAL SKIN The intercostal nerves go under the costal margins and enter in between the transversus abdominus and the internal oblique muscle. In the mid axillary line they send off a lateral branch while the anterior branch continues on to only supply muscles UNTIL they emerge along the midline through the rectus as anterior cutaneous nerves and cover skin over the rectus sheath The lateral branches of the intercostal nerves are the ones that cover the skin up to the lateral border of the rectus sheath. They come out and innervate skin at the axillary line and descend in a diagonal. So there are really two sets of nerves going diagonally across the abdomen. The lateral branches come out at the axillary line and cover the innervation of the skin and the anterior branches course with the ribs and then cross the cartilage and enter the space between the transversus abdominus and internal oblique and innervate the musculature of the abdomen and then only become cutaneous as the anterior cutaneous nerves as the perforate the sheath of the rectus muscles and innervate the skin over the rectus sheath. Woodburne page 366 and also parts of page 427 and 428 So the TAP block is really only helping to block the nerves that emerge and become cutaneous near the midline of the abdomen and probably does not help with any cutaneous innervation lateral to the rectus sheath. UNLESS the local were to seep posteriorly and get to the area where the lateral branches of the intercostal nerves were taking off