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Background and Aims Peritoneal dialysis (PD) is an established method for renal replacement therapy in patients with end-stage renal disease (ESRD) who may pose significant anaesthetic challenges due to multi-system co-morbidities with organ dysfunction.

Methods Our patient is a 82 year old gentleman with ESRD secondary to hypertension, hyperlipidemia, diabetes and aortic valve replacement on long term warfarin. With the external oblique, internal oblique and transversus abdominis muscles visualized using ultrasound at level of anterior axillary line between 12th rib and the iliac crest, a single shot right-sided posterior TAP block was performed with an insulated 21Gauge stimuplex needle using ‘in plane’ technique. 20ml of 0.5% Ropivacaine was deposited between internal oblique and transversus abdominis after confirmation of negative aspiration. The patient tolerated the surgery well, with no complaint of pain or additional oral analgesia required 24hours after procedure. No complications such as infection, haematoma or local anaesthetic related toxicity were documented.

Results Use of TAP block has been proven to be an effective technique for surgery involving anterior abdominal wall. TAP block allows sensory blockade of lower abdominal wall including analgesia of skin, muscles and parietal peritoneum of the anterolateral abdominal wall and avoid GA in these patients. It also provides some analgesia during early post-operative stage and helps reduce postoperative opiate requirements and opioids-related side effects.

Conclusions US-guided posterior TAP block is an effective method and should be considered an anesthesia technique of choice for PD catheter placement in ESRD patients with major comorbidities.