Background and Aims Ultrasound-guided transversus abdominis plane (TAP) block is a regional anaesthesia technique which, as part of a multimodal analgesia regimen, may provide an alternative to epidural analgesia. We report 3 cases of patients where a bilateral dual TAP block (subcostal and lateral approaches) was used to minimize opioid use after major abdominal surgery.

Methods

1. 73 years’ old female, ASA III, with advanced ovarian carcinoma and extensive peritoneal carcinomatosis, who underwent emergency median laparotomy and colostomy for intestinal occlusion;

2. 67 years’ old female, ASA III, with localised scleroderma scheduled for open left hemicolectomy for a colon tumour;

3. 62 years’ old male, ASA II, scheduled for hand-assisted laparoscopic resection of a rectal tumour.

MethodsA total intravenous anaesthesia and multimodal IV analgesic regimen were used, including paracetamol, non-steroid anti-inflammatory and dexamethasone, alongside an ultrasound guided bilateral dual TAP block at the start of the procedure, with a total of 50–60 mL ropivacaine 0.2% and adequate spread in the relevant planes. Tramadol or morphine were used postoperative as needed.

Results Post-operative IV opioid consumption was 12mg morphine or 300mg tramadol in 24 hours, with no opioids required after 48 hours. The pain was well controlled (maximum 2 at rest and 3 with movement out of a 11 points visual analogue scale). The patients reported high satisfaction and no nausea.

Conclusions Bilateral dual TAP block was part of an effective opioid-sparing multimodal analgesia for major abdominal surgery, and its benefits as an alternative to epidural analgesia may merit further study.