Ultrasound guided transversus abdominis plane (TAP) block for inguinal surgery in a case with severe kypho-scoliosis and pectus excavatum

Abstract

Presence of severe thoracolumbar kyphoscoliosis with pectus excavatum (PE) is more than a cosmetic
deformity and causes cardiopulmonary impairment with physiologic limitations. These patient have risk
of rise in pulmonary artery pressures during laryngoscopy and intubation. Moreover, due to a noncompliant
chest wall, these patients are prone to develop inadequate postoperative ventilation, postoperative
hypoxemia, and difficult extubation with delayed weaning from ventilatory support. A case
with both severe kyphoscoliosis (Cobb’s angle >90°) and PE, presented for excision and debridement
of infected inguinal swelling. We hereby discuss the anaesthetic challenges, and the importance of early
planning of anaesthetic techniques for successful perioperative management in cases with anatomical
deformities of thoracolumbar column and rib cage. The utility of ultrasound guided TAP block in
providing surgical anaesthesia for inguinal or superficial abdominal surgeries has also been highlighted
in this report.