Transversus abdominis plane block under ultrasound guidance in infant suffering from brain disease

Case Report: A male infant aged 4 months and weighing 4.8 kg suffering from cerebrovascular outcomes with frequent bouts of spontaneous apnea or resulting from noxious stimuli was brought to our attention to undergo recanalization surgery after ileostomy procedure. Due to the risk of postoperative apnea, we decided to significantly reduce the doses of general anesthetics combining an ultrasound transversus abdominis plane (TAP) block. The infant was intubated and maintained with a light mixture of air, oxygen, sevoflurane, and a single administration bolus of fentanyl 2 µg/kg without any use of curare. As the second step, a TAP block was performed under ultrasound guidance with levobupivacaine 0.25% (0.3 mL/kg). No other anesthetic drugs were necessary during the duration of surgery (2 hours). At the end of surgery, the child was extubated with rapid resumption of spontaneous breathing and appeared calm with the absence of pain.

Discussion and Learning Points: The TAP block can be usefully applied in all clinical situations where general anesthesia and administration of opioids for postoperative pain control can cause postoperative apnea.