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Abstract
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Background and Aims TAP block is a well established peripheral nerve block in the adult as well as pediatric population, with an increasing number of reports of its successful use in neonates. However, its use in extremely low birth weight (ELBW) neonates is still somewhat unknown.
Methods A premature neonate born at GW 33, now 44 days old and weighing only 900g, presented for ileostomy necessitated by intestinal hypomotility. Medical history was significant for coarctation of the aorta, with significant differences in arterial tension between the upper and lower extremities. After placement of two peripheral venous lines and an arterial line induction was performed with Thiopental, Rocuronium. The patient was intubated and anesthesia was maintained with Sevoflurane. We performed preoperatively an US-guided right-sided subcostal TAP block, using 0,2ml of 2% Lidocaine and 1ml of 0,1% Levobupivacaine.
Results For the entirety of the surgery the patient maintained hemodynamic and respiratory stability, without the need for opioids, repeat rocuronium, or vasoactive/inotropic support. At the end of the surgery the patient was successfully extubated and transported to the NICU, without the need for rescue analgesia in the following 24h.
Conclusions This case highlights the importance of regional anesthesia and its effective application even in ELBW neonates. To our knowledge there are no recorded cases of TAP block in patients of lower weight. Additionally, opioid free anesthesia enables quicker establishment of spontaneous breathing, superior ventilatory mechanics, and ultimately sooner extubation.
Needle tip position
Spread of local anesthetic