Neural blockade of the thoracolumbar nerves supplying the anterior abdominal wall through transversus abdominis plane (TAP) has been investigated for different applications mainly for the
acute pain management following abdominal
surgical procedures. The role of this block for
chronic pain syndromes is still to be discovered, and its value in chronic
abdominal pain needs to be studied. We are presenting new application of the TAP technique for management of chronic
abdominal pain syndrome using the continuous infusion.
CASE REPORT: We present a case of an 18-year-old girl who underwent an uneventful
laparoscopic cholecystectomy. Postoperatively, patient complained of
chronic pain at the site of the surgery. All diagnostic and imaging studies were negative for a surgical or a medical cause. Multiple interventions including epidural blocks, transcutaneous electrical neural stimulation, and celiac plexus blocks had failed to relieve the
pain. After discussion with the patient about the diagnostic nature of the procedure and the likelihood of recurrence of
pain, TAP block was performed on the right side with significant improvement of
pain for about 24 hours. The degree of
pain relief experienced by the patient was very dramatic, which encouraged us to proceed with an indwelling TAP
catheter to allow for continuous infusion of a
local anesthetic. The patient was sent home with the continuous infusion through a TAP
catheter for 2 weeks. From the day of
catheter insertion and up to 9 months of follow-up, patient had marked improvement of her
pain level as well as her functional status and ability to perform her daily activities, after which our
acute pain team stopped following the patient.
CONCLUSION: