Ultrasound-guided transversus abdominis plane catheter for chronic abdominal pain.
OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
A successful TAP block confirmed the peripheral (somatic) source of the abdominal pain and provided temporary analgesia after which an indwelling catheter was inserted, which provided prolonged pain relief.
Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA. guirgum@ccf.org
Maged N
MN
Guirguis
Alaa A
AA
Abd-Elsayed
Girgis
G
Girgis
Loran Mounir
LM
Soliman
D000009:Abdominal Muscles / Q000000981:diagnostic imaging; D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D034861:Abdominal Wall / Q000000981:diagnostic imaging*; D000293:Adolescent; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D002408:Catheters, Indwelling; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D005260:Female; D006801:Humans; D009407:Nerve Block / Q000379:methods*; D009437:Neuralgia / Q000188:drug therapy / Q000209:etiology; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D014221:Triamcinolone / Q000008:administration & dosage; D014463:Ultrasonography
D000779:Anesthetics, Local; D014221:Triamcinolone; D002045:Bupivacaine