Abdominal paracentesis is a key diagnostic and therapeutic interventionin patients with ascites

Transversus abdominis plane (TAP) block is most often used for post-operative pain management in abdominal surgeries

TAP blocks are being increasingly utilized in the ED for conditions suchas appendicitis, rectus sheath hematomas, renal colic, and abdominalwall abscesses1-5

This is the first reported ED case of a TAP block used as part of a pain management strategy for paracentesis, demonstrated in a patient suspected peritonitis

33-year-old female with alcoholic cirrhosis presented with abdominal pain with distension, and chill

Vital signs notable for tachycardia

TAP block w/ 30mL 0.25% Bupivacaine performed prior to paracentesis

Pre-block pain was 8/10; 45 minutes after she endorsed near-complete sensory loss to the right hemi-abdomen 

Felt pressure during paracentesis but denied pain during insertion of the paracentesis needle 

2,200ml of serous fluid drained uneventfully and pain was well controlled for the entire ED stay

Fluid studies ruled out spontaneous bacterial peritonitis, and patient was admitted to the hospital and discharged after six days

With AASLD guidelines recommending a diagnostic paracentesis for all hospitalized cirrhotic patients with ascites, ED-performed diagnostic paracenteses will become more frequent

TAP block provide effective analgesia prior to paracentesis, improving comfort and minimizing opioid use – important in cirrhotic patients who may have contraindications to systemic sedatives

Incorporating ultrasound-guided regional anesthesia into standard EDpractice can improve procedural tolerance and provide valuable skill-building opportunities for early learners in regional anesthesia

Limitations include prolonging an already time-intensive procedure in the ED and increased resource utilization with cardiac monitoring and post-procedure observation

TAP blocks are a safe and effective adjunct for pain control in patients undergoing paracentesis in the Emergency Department

This case highlights the value of regional anesthesia as part of a multimodal pain strategy, especially in patients with severe ascites