# Ultrasound-guided transversus abdominis plane block as an adjunctive anesthesia technique in elderly patients with combined massive ascites: a case report and literature review

## TL;DR

This case report shows that ultrasound-guided TAP block can safely provide effective pain relief during surgery in elderly patients with large amounts of abdominal fluid.

## Contribution

Demonstrates the safe and effective use of TAP block in elderly patients with massive ascites, a rarely documented scenario.

## Key findings

- The patient maintained hemodynamic stability during surgery with no significant blood pressure or heart rate changes.
- Postoperative pain was minimal, and no adverse effects were reported.
- TAP block provided effective analgesia and improved anesthetic outcomes in this high-risk patient.

## Abstract

The ultrasound-guided transversus abdominis plane (TAP) block has emerged as an effective adjunctive analgesic technique for abdominal surgery. However, its use in older patients with significant ascites has been rarely documented. This report presents the anesthetic management of an older patient with massive ascites undergoing open laparotomy for an ovarian tumor. Preoperatively, 30 mL of 0.2% levobupivacaine was injected into the TAP under ultrasound guidance. The procedure was uneventful, with approximately 9,000 mL of ascitic fluid drained, along with the removal of a 13 × 13 × 7-cm left ovarian mass, an 8 × 5.5 × 4-cm uterus, and a 3.5 × 1 × 0.5-cm right ovary. Throughout the surgery, the patient maintained hemodynamic stability, with no significant fluctuations in blood pressure or heart rate. Postoperatively, the patient reported minimal pain and experienced no adverse effects. These findings highlight the effectiveness of ultrasound-guided TAP block as an auxiliary anesthesia technique, providing enhanced analgesia, promoting hemodynamic stability, and improving overall anesthetic outcomes in older patients with substantial ascites.