Plane Block Research Articles

Tudy of Dexmeditomidine as an adjuvant to bupivacaine in Ilioinguinal, Iliohypogastric nerve block in transverse abdominis plane in lower abdominal surgeries

tudy of Dexmeditomidine as an adjuvant to bupivacaine in Ilioinguinal, Iliohypogastric nerve block in transverse abdominis plane in lower abdominal surgeries

Continuous ESP Block Technique for an Open Thoracotomy in Neurofibromatosis Patient

Neurofibromatosis remains a challenge for the anesthesiologist as it brings issues especially regarding safety of anesthetic management such as airway management and neuraxial anesthesia. We report a case of a 60 year-old woman with controlled clinical comorbidities and neurofibromatosis, admitted for an open thoracotomy for excision of a growing pulmonary lesion, highly suspicious for malignancy. She had cutaneous tumors covering the majority of her skin. No neuroimage was available to exclude neuraxial or intracranial tumors, ensuring the safety for neuraxial anesthesia, therefore a combined technique was proposed with general anesthesia and a continuous erector spinae plane (ESP) block for anesthesia and analgesia. Surgery occurred successfully and there was no need to supplement or alter the initially planned anesthetic technique. Patient referred pain score ranging from 0-1 in rest and motion postoperative and required no complementary opioid for pain control. Infusion in the ESP catheter was maintained for 48h, after which it was removed and patient discharged without further complications or pain.

Comparison of ultrasound guided transversus abdominis plane (TAP) block by posterior and lateral approach for their analgesic efficacy after lower abdominal surgery

Comparison of ultrasound guided transversus abdominis plane (TAP) block by posterior and lateral approach for their analgesic efficacy after lower abdominal surgery

Pain control in laparoscopic surgery: a case-control study between transversus abdominis plane-block and trocar-site anesthesia.

Local anesthesia in laparoscopic operations is gaining increasing consensus. To standardize analgesia, a prospective case-control study was created over a 1-year period, in collaboration with the anesthesiology service in our community hospital. Starting from February 2016, we prospectively enrolled adult patients (more than 16years old) undergoing laparoscopic appendectomy or cholecystectomy, either in emergency or elective setting. Patients were preoperatively assigned (based on the chart-admission number) either to transversus abdominis plane (TAP) block treatment (Group 1-experimental arm) or trocar-site anesthesia (TSA) (Group 2-experimental arm), and then compared with group of patients not submitted to treatment (Group 3-control arm). Demographic and clinical characteristics of each patient were recorded. Post-operative pain level (primary outcome) was assessed with visual analog scale (VAS) score; analgesic use and length of stay in hospital were defined as secondary outcomes. Forty-two patients were assigned to TAP block treatment (Group 1), fifty-two to TSA (Group 2), and thirty-nine underwent no pre-incisional treatment (Group 3). In the comparison between patients undergoing TAP block or TSA with the control arm, a significance difference in reported pain was recorded in every scheduled time (p < 0.05 at 0, 6, 12, 18, 24, and 48h from awakening). Both local anesthesia groups share a benefit in terms of primary outcome. The use of pre-incisional TSA for all the patients undergoing laparoscopic cholecystectomy and appendectomy could become a routine practice to reduce post-operative pain both in the elective and emergency setting.

Different Approach to Post-operative Pain Management: Trans Abdominis Plane (TAP) Blocks

Different Approach to Post-operative Pain Management: Trans Abdominis Plane (TAP) Blocks

Early versus delayed feeding after placement of percutaneous endoscopic gastrostomy tube with safe anesthetic techniques

Objective To compare the safety of early (≤4 h) versus 24 h tube feeding after percutaneous endoscopic gastrostomy (PEG) tube placement and to determine the effectiveness of i.v. sedation combined with ultrasound-guided, left side transversus abdominis plane (TAP) block versus combination with local anesthetic (LA) infiltration for PEG placement. Background Tube feeding used to be delayed up to 24 h after PEG placement, but results from many randomized controlled trials revealed that there was no need for delaying the tube feeding. The procedure was earlier done with general anesthesia or i.v. sedation with LA infiltration, but the use of i.v. sedation with TAP block may be another option. Patients and methods This was a prospective randomized study including 60 patients, requiring long-term nutritional support, who underwent the PEG procedure at GIT Endoscopy Unit, Damanhour Teaching Hospital, El Beheira, Egypt; between August 2017 and March 2018. Patients were randomly allocated into two equal groups, in group A; early tube feeding (≤4 h) was done and performed with i.v. midazolam and propofol-based sedation combined with ultrasound-guided, left side TAP block, whereas in group B; delayed tube feeding (24 h postprocedure) was done and performed with i.v. midazolam and propofol-based sedation with LA infiltration. Results There were no statistically significant differences between both groups with respect to procedure-related or anesthesia-related complications. Conclusion Early tube feeding (≤4 h) after PEG placement may be a safe option to delayed (24 h postprocedure) feeding. I.v. sedation combined with ultrasound-guided, left side TAP blockade can be used successfully as the primary anesthetic modality for PEG placement.

Novel use of laparoscopic-guided TAP block in total laparoscopic hysterectomy

Background: Transverse abdominis plane (TAP) block is a peripheral nerve block designed to anaesthetise the nerves supplying the anterolateral abdominal wall (T6 to L1). We introduced laparoscopic TAP block at Ninewells Hospital in 2014 and present a retrospective study assessing its efficacy. To our knowledge, there is limited study done on laparoscopic-guided TAP block whilst there are abundant literatures available on ultrasound-guided TAP block.Aims: To evaluate the efficacy of laparoscopic-guided TAP block as postoperative analgesia following total laparoscopic hysterectomy (TLH).Methodology: A retrospective study was done between November 2014 to October 2016 (24 months) comparing patients who had TLH with TAP block (Group 1; n = 45) and patients who had TLH without TAP block (Group 2; n = 31) in our gynaecology unit. Patients were identified from theatre database. Data was collected from clinical portal and medical notes. The data included demographic information, BMI, METS score, intra-operative opiates use, post-operative pain scores, opiate requirements and use of patient-controlled analgesia (PCA), total dose of opiates used and day of discharge. The outcomes were analysed using means, odds ratios (OR), Mann–Whitney U-test and Fisher’s exact or Chi-square test with 95% confidence interval (CI).Results: Patients in Group 1 were older (mean age of 64.4, range 38–87) when compared to Group 2 (mean age of 49.3, range 37–81). Group 1 and 2 had comparable mean BMI (30.34 vs. 30.02) and METS score (6.77 vs. 7.76). Mean post-operative pain scores were lower in Group 1 within 4 hours, in periods of 4–12 hours, 12–24 hours and 24–48 hours post-op. Smaller proportion of patients in Group 1 required opiates post-operatively in all periods as compared to Group 2. This was statistically significant in the periods of 12–24 hours post-op (OR 0.31, 95% CI 0.11–0.82; p = .01). PCA use was significantly lower in Group 1 (OR 0.02, 95% CI 0.0014–0.46; p = .01). Group 1 had lower mean total dose of opiates used (27.182 mg, range 0–102 mg) than Group 2 (59.452 mg, range 0–240 mg), which was statistically significant (p < .0001). Average post-op hospital stay was 1.3 and 1.8 days in Group 1 and 2, respectively.Conclusion: Laparoscopic-guided TAP block delivered as post-operative analgesia following TLH results in reduced opiate requirement at post-operative period 12–24 hours, reduced PCA use and lower total dose of opiates used.

Efficacy of ultrasound-guided transversus abdominal plane and posterior rectus sheath block for postoperative analgesia in patients undergoing radical resection for gastric cancer

Objective To evaluate the efficacy of ultrasound-guided transversus abdominal plane (TAP) and posterior rectus sheath (PRS) block for postoperative analgesia in the patients undergoing radical resection for gastric cancer. Methods One hundred twenty patients of both sexes, aged 18-64 yr, with body mass index of 19-25 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective radical resection for gastric cancer, were divided into 2 groups (n=60 each) using a random number table: control group (group C) and ultrasound-guided TAP and PRS block group (group T+ R). Bilateral TAP (0.375% ropivacaine 0.5 ml/kg was injected) and PRS block (0.375% ropivacaine 0.3 ml/kg was injected) were performed before induction of general anesthesia in group T+ R.Patient-controlled intravenous analgesia was provided to all the patients after surgery in the two groups, and the visual analog scale score at rest and during activity was maintained less than 4 within 48 h after surgery.The requirement for rescue analgesia within 48 h after surgery and occurrence of adverse reactions during the analgesia period were recorded. Results Compared with group C, the requirement for rescue analgesia within 48 h after surgery and incidence of nausea and vomiting were significantly decreased in group T+ R (P<0.05). Conclusion Ultrasound-guided TAP and PRS block provides better efficacy for postoperative analgesia with less adverse reactions in the patients undergoing radical resection for gastric cancer. Key words: Ultrasonography; Abdominal muscles; Nerve block; Analgesia; Stomach neoplasms

Single-shot pectoral plane (PECs I and PECs II) blocks versus continuous local anaesthetic infusion analgesia or both after non-ambulatory breast-cancer surgery: a prospective, randomised, double-blind trial

BackgroundPectoral plane blocks (PECs) are increasingly used in analgesia for patients undergoing breast surgery, and were recently found to be at least equivalent to single-shot paravertebral anaesthesia. However, there are no data comparing PECs with the popular practice of continuous local anaesthetic wound infusion (LA infusion) analgesia for breast surgery. Therefore, we compared the efficacy and safety of PECs blocks with LA infusion, or a combination of both in patients undergoing non-ambulatory breast-cancer surgery. MethodsThis single-centre, prospective, randomised, double-blind trial analysed 45 women to receive either PECs blocks [levobupivacaine 0.25%, 10 ml PECs I and levobupivacaine 0.25%, 20 ml PECs II (PECs group); LA infusion catheter (levobupivacaine 0.1% at 10 ml h−1 for 24 h (LA infusion group); or both (PECs and LA infusion)]. The primary outcome measure was area under the curve of the pain verbal rating score whilst moving vs time (AUC) over 24 h. Secondary outcomes included total opioid consumption at 24 h. ResultsAUC moving was mean (SD) 71 (34) mm h−1vs 58 (41) vs 23 (20) in PECs, LA infusion, and both, respectively; P=0.002. AUC at rest was also significantly lower in patients receiving both. The total 24 h opioid consumption [median (25–75%)] was 14 mg (9–26) vs 11 (8–24) vs 9 (5–11); P=0.4. No adverse events were observed. ConclusionsThe combination of both pre-incisional PECs blocks and postoperative LA infusion provides better analgesia over 24 h than either technique alone after non-ambulatory breast-cancer surgery. Clinical trial registrationNCT 03024697.

Comparison of Liposomal Bupivacaine for Pain Management after Immediate and Delayed Deep Inferior Epigastric Perforator Free Flap Reconstruction

Patient analgesia can be addressed pre, intra and post-operatively. The utilization of local anesthetics administered intra-operatively is limited by the medication’s short duration of action. However, an intraoperative transversus abdominis plane (TAP) block can be utilized to anesthetize the T6-L1 intercostal nerves that supply the anterior abdominal wall. This provides analgesia to the abdominal wall, which has been identified as the largest source of post-operative pain following abdominally-based autologous tissue breast reconstruction.

Anatomical topography of the inferior lumbar triangle for transversus abdominis block.

Rapid development of anesthetic techniques of thoracic paravertebral block required to redefine anatomical landmarks of the inferior lumbar (Petit) triangle (ILT). Anesthesiologists are mainly interested in the ILT to perform the transversus abdominis plane (TAP) block. The aim of this study was to provide comprehensive information of the ILT to improve the success of TAP block. Descriptional anatomy of ILTs such as dimensions, space, area, and types was analyzed in 25 preserved adult male cadavers. The ILT was identified in 100% out of all explored cadavers' lumbar regions. The predominant triangle was the acute-angled shaped (46%). The ILT in terms of the surface area was classified into four distinct types: Type I with a surface area <8cm2 was identified in 50%. Type II or intermediate triangles with a surface area of 8-12cm2 were detected in 36%. Type III or large triangles with a surface area >12cm2 were found in 14%. Type 0 or no triangle did not exhibit a triangle. For the orientation zone over the posterior lumbar region, it was measured with the distances from the posterior median line (M) to the apex (A), medial point (B), and lateral point (C) of the triangle. MA; as M1A transverse line: 103.3±21.3mm (left) and 106.4±18.4mm (right), MB; as M2B transverse line; 102.4±21.8mm (left) and 105±17.9mm (right), MC; as M3C transverse line; 119±20.5mm (left) and 120±19.2mm (right) were measured. In addition, the measurements of the vertical lines were measured. M1A-M2B and M1A-M3C vertical lines were 20.1-22.8mm (left-right) and 30-29mm (left-right), respectively. The shape, the size, useful points, geometry, and topography of the ILT are important to determine the orientation points during block procedures. It is possible to visualize the needle pathway in different shape of ILT to ultrasound-guided TAP block. Anesthetic intervention needs to be individualized, depending upon the size of the triangle. The findings may be useful in establishing the area with the highest probability of localization of the ILT which can improve both the safety and efficiency of TAP block.

Peritoneal Dialysis Catheter Surgery Using Transversus Abdominis Plane Block

Peritoneal dialysis (PD) catheter surgery can be performed using regional anesthesia. We present our PD catheter placement and extraction experience using ultrasound-guided transversus abdominis plane (TAP) block. In the present study, we analyzed 74 patients from our center with end-stage renal disease (ESRD) who underwent PD catheter placement (60 patients) and removal (14 patients) using a TAP block between June 2011 and December 2015. The TAP block was successful for 55/60 (91.7%) patients (insertion) and 13/14 (92.9%) patients (extraction). Other patients had pain at the incision site and required general anesthesia. There were no anesthesia-, surgery- or PD catheter-related complications. The TAP block is a safe and effective technique not only for high-risk ESRD patients but for all patients undergoing PD catheter placement or extraction.

Clinical Effectiveness of Transversus Abdominis Plane (TAP) Blocks for Pain Relief After Caesarean Section

Abstract Background The effectiveness of transversus abdominis plane (TAP) blocks for acute pain relief after caesarean section, in comparison to normal practice, remains uncertain. Methods Electronic literature databases were searched from inception to May 2016 for randomised controlled trials that assessed the effectiveness of TAP blocks following caesarean section. Trials were eligible if comparisons were made against no block or placebo, and/or intrathecal morphine. Risk of bias was assessed using the Cochrane tool. Data for consistent outcomes were subject, where possible, to meta-analysis and presented as either mean differences with 95% confidence intervals or incidence of a particular event. Results Twenty published studies fulfilled our inclusion criteria. TAP blocks significantly reduced pain at rest both when compared with placebo or no TAP blocks (−0.96, 95% CI −1.67 to −0.25, P =0.008) and intrathecal morphine (1.10, 95% CI 0.59 to 1.60, P P =0.005 and 1.35, 95% CI 0.76 to 1.94, respectively, P P P =0.25) and given in co-administration (0.00, 95% CI −0.10 to 0.10, P =1.00). Conclusion TAP blocks provide effective analgesia after caesarean section; however, additional benefits are more difficult to demonstrate when long-acting intrathecal opioids are administered.

The Impact of Single Low Dose IV Magnesium Sulphate Adjuvant to Ultrasound Guided Transverses Abdominis Plain Block for Control of Postcesarean Pain

Objective: The aim of this study is to determine the role of preoperative low dose intravenous MgSO4 when given adjuvant to ultrasound guided transversus abdominis plane (TAP) block in augmenting postcesarean analgesic effects and reducing opioid requirements during the first 24 hours. Subjects and Methods: In this prospective, randomized double blind study, a total of sixty full term pregnant women were recruited for the study underwent caesarean section. Thirty patients were assigned to MgSO4 group (A) and another thirty to placebo group (B). Participants in group (A) received 50 mg/kg MgSO4 in 100 ml isotonic saline intravenous (IV) over 20 minutes prior to induction of general anesthesia by 30 minutes while participants in group (B) received 100 ml isotonic saline (placebo) by the same route and over the same duration as control. Results: Visual Analogue Scale (VAS) was analysed within 24 hours postoperatively. The mean pain score at 6 and 12 hours postoperatively was significantly lower in MgSO4 group compared to control group (40.4 ± 5.12 vs 53.6 ± 4.92; 26.1 ± 3.01 vs 35.5 ± 3.98 respectively, p = 0.012, 0.005). Comparing both groups regarding the mean time interval of first rescue analgesia (morphine sulphate) requested by the patients, it was longer in MgSO4 group compared to control group. The total dose of rescue analgesia consumed during 24 hours was analysed and it was significantly higher in control group compared to MgSO4 group (10.1 ± 0.95 vs 6.2 ± 0.87, p = 0.001). Conclusion: We concluded that preoperative low doses (50 mg/Kg) of MgSO4 with general anesthesia combined with ultrasound guided TAP block offer longer postoperative pain free periods thus reducing total opioid consumption. In addition to the safety of the drug to the mother and fetus so we recommend IV MgSO4 as an adjuvant therapy with TAP block.

Ultrasound-guided TAP Block with or without Dexmedetomidine vs. Local Infiltration of the Wound after Open Herniorrhaphy: A Randomized Prospective Controlled Study

Objectives: Transversus abdominis plane (TAP) block and local anesthetic wound infiltration (LAI) can provide a variable effective pain relief at the wound site after surgery. This prospective study was designed to evaluate the postoperative analgesic efficacy of TAP with or without dexmedetomidine compared with LAI of the wound after herniorrhaphy.Materials and methods: Sixty adult patients were divided into 3 groups of 20 patients each. Group1 (TAPD): Patients received single shot ultrasound-guided (US) TAP block using 15 mL of levobupivacaine 0.5% mixed with 0.9 μg/kg of dexmedetomidine. Group 2 (TAP): Patients received single shot US guided TAP block using 15 mL of levobupivacaine 0.5%. Group 3 (LAI): Patients received local anesthetic infiltration (LAI) patients received local infiltration using 15 mL of levobupivacaine 0.5%. The following parameters were assessed at, 2, 10, 18 and 24 h postoperatively: postoperative duration of analgesia, analgesic pain scores using the visual analogue scale (VAS) for pain, amount of supplemental intravenous morphine, postoperative nausea and vomiting during 24 h.Results: We found that a lower significant difference (P<0.05) of VAS pain scores at rest and on movement between group TAPD and group TAP at time 24 h postoperatively. Also, there was a lower significant difference (P<0.05) of VAS pain scores at rest and on movement between group TAPD and group LAI at 10, 18 and 24 h. Moreover, there was a lower significant difference (P<0.05) between group TAP and group LAI at times 10 and 18 h. Also, supplemental morphine consumption within 24 h was a statistically higher (P<0.05) in group LAI compared to groups TAPD and TAP.Conclusion: Using dexmedetomidine as an additive to levobupivacaine in ultrasound-guided TAP block for herniorrhaphy provides prolonged duration of postoperative analgesia, and lowered VAS pain scores. Also local anesthetic infiltration can give accepted postoperative analgesia but with shorter duration than TAP block

Ultrasound-guided Supraclavicular Nerve Block In-plane Technique: Comparison of Conventional vs Skin Wheal Standoff Technique

Introduction: The foremost advantage of ultrasound-guided peripheral nerve blocks is visualization of anatomical structures of interest and then depositing the local anesthetic for block. Supraclavicular block is the very commonly used block for upper limb surgeries. Aim: The aim of our study is that for greater efficacy and safety of our blocks, we should use a technique in which we are not only visualizing the anatomical structures, but also the complete needle path and ultimately the deposition of local anesthetic in the vicinity of nerves and having a safe distance from adjacent structures like vessels and pleura. Materials and methods: A total of 60 patients were accepted for study and divided into two groups of 30 each randomly. In group I, ultrasound-guided supraclavicular nerve block was given with skin wheal oblique standoff technique and in group II, the usual technique. Both the groups were compared in terms of better needle visualization, number of attempts, and success of block. Results: In group I, we were able to visualize the complete path of needle in 70% of cases in first attempt as compared with group II in 40% of cases. In group I, 70% of blocks were placed in the first attempt as compared with 33% in group II. The p-value was <0.005 and difference was statistically significant. Similarly, operator fatigue, time for block placement, and corner pocket visualization were better in group I. Conclusion: We have an opinion and recommendation from this study that by simple modification of the usual technique of giving supraclavicular block, i.e., raising a skin wheel, we can achieve greater success with our procedure.

Classification of cardiac excitation patterns during atrial fibrillation

Abstract The goal of this research was to classify cardiac excitation patterns during atrial fibrillation (AFib). For this purpose, virtual models of intracardiac mapping catheters were moved across in-silico cardiac tissue to extract local activation times (LATs) of each catheter electrode from simulated cardiac action potential (AP) signals. The resulting LAT patterns consisting of the LATs of all electrodes resemble patterns measured in clinical cases. The LATs represent the input information for features that were used to separate four different excitation patterns during AFib. Those four excitation patterns were plane wave, ectopic focus (spherical wave), rotor (spiral wave) and block. A feature selection algorithm was used to investigate the features concerning their power to classify the different simulated excitation patterns. The scores of the selected features were used to train and optimize a support vector machine (SVM). The optimized and cross-validated SVM was then used to classify the simulated cardiac excitation patterns. The achieved overall classification accuracy of this SVM model was 98.4 %.

Comparative study evaluating the efficacy of ultrasound-guided transversus abdominis plain block versus intraperitoneal injection of local anesthetics in pain control following laparoscopic colectomy

Background Laparoscopic surgeries are being widely conducted nowadays for its well-known advantages such as less postoperative pain, shorter length of hospital stay, decreased morbidity and mortality, and reduced healthcare costs. Many analgesic modalities have been applied for this type of surgery, of which we have chosen the intraperitoneal injection (IP) of local anesthetics and the transversus abdominis plane (TAP) block. We studied the effect of both techniques on postoperative pain scores and their effect on abdominal and shoulder pain after laparoscopic colectomy. Patients and methods Fifty patients were enrolled in the study. All of them were of American Society of Anesthesiology (ASA) physical status I or II and scheduled for elective laparoscopic colectomy surgery. Patients were randomly allocated into one of two groups (25 patients each): the TAP block group (TAP group) and the IP of local anesthetics group (IP group). Pain score using the numerical rating scale (NRS), hemodynamic parameters, amount of consumption of rescue analgesia, shoulder pain, and adverse reactions were recorded. Results The main outcome variable was the pain score in the immediate postoperative period and the next 3 h; the mean NRS scores were lower in the TAP group than in the IP group in the previously mentioned time periods, with a highly significant difference. Also, there was a significant difference in the NRS score at the fourth hour postoperatively; however, the subsequent NRS scores at the different time intervals showed no significant difference until the end of the 24th hour postoperatively. In the TAP group, 20 patients (80%) complained of abdominal pain at least once in the first 24 h after surgery, whereas all the patients in the IP group experienced abdominal pain, with a significant difference between the two groups. The overall analgesic consumption in milligrams and the total number of analgesic doses were found to be less in the TAP group, with a highly significant difference. Conclusion The results of this study demonstrated that the TAP block is a more effective analgesic modality for abdominal pain than the IP local anesthetic during the early postoperative period after laparoscopic colectomy but IP is more effective in relieving postoperative shoulder pain.

The Utility of the Transverse Abdominus Plane (TAP) Block in Minimally Invasive Gynecologic Surgery: A Randomized Double Blinded Clinical Trial.

The Utility of the Transverse Abdominus Plane (TAP) Block in Minimally Invasive Gynecologic Surgery: A Randomized Double Blinded Clinical Trial.

Ultrasound guided TAP block versus ultrasound guided caudal block for pain relief in children undergoing lower abdominal surgeries

ObjectiveUltrasound guided transversus abdominis plane (TAP) nerve block and caudal analgesia are safe and effective methods in children. The aim of the study was to compare the effectiveness and safety of both methods.Methods60 patients were randomly allocated into 3 groups: group A: (n = 20) received ultrasound guided transversus abdominis plane (TAP) block; group B: (n = 20) received ultrasound guided caudal block and group C: (n = 20) received conventional analgesia to be considered as controlled group. Hemodynamics, pain scores of Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) and objective pain score (OPS), postoperative complication, satisfaction of the patients and parents and postoperative analgesic requirements were recorded.ResultsThere was no significant difference between the three groups in mean arterial blood pressure and heart rate. Postoperative analgesia requirements were significantly higher in group B compared to group A, meanwhile it was significantly higher in group C compared to both groups A and group B. There was significant difference between group A and group C in pain scores assessment but no significant difference between group A and group B. Patient and parent satisfaction was markedly observed in groups A & B more than group C (the control group) and more satisfaction in group A than group B.ConclusionTAP block and caudal block under ultrasound guidance proved to be safe with no recorded complications either intra or postoperatively. Patient and parent satisfaction was markedly observed in case of TAP block.