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Background and Objectives: 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: 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., (© 2012 The Authors. Pain Practice © 2012 World Institute of Pain.)

The abdominal wall consists of three muscle layers—the external oblique, the internal oblique, and the transversus abdominus—and their associated fascial sheaths. The neuronal afferents course through the neurofascial plane between the internal and the transversus abdominus muscles—the “transversus abdominus plane” (TAP). The TAP block is used to produce a dermatomal sensory block of the lower six thoracic and upper lumbar abdominal afferents. It was shown to be effective in providing postoperative analgesia after various lower abdominal procedures, mainly radical prostatectomy, large bowel resections, and gynecologic procedures as well as cesarean sections. The recent introduction of ultrasound (US) to different regional anesthesia procedures allows more accurate and safer performance of peripheral nerve blocks. With US imaging, the muscle layers are visible from the rectus medially through the aponeurotic area at the edge of the rectus to the three distinct layers of external, internal oblique, and transversus abdominus in the lateral abdominal wall. Installation of local anesthetics in this plane anesthetizes the anterior abdominal wall on this side. This block can be used as a diagnostic tool or as a therapeutic modality via a continuous indwelling catheter for postoperative lower abdominal pain or chronic pain syndromes arising from the anterior abdominal wall. [Copyright &y& Elsevier]