TAP BLOCK LEADING TO A DIAGNOSTIC MISTAKE - A CASE REPORT
7 slide(s) – English – 2011-09-08
TAP Block leading to a diagnostic mistake – a case report
Background and Aims:
The transversus abdominus plan (TAP) block has gained a new notoriety in abdominal wall analgesia with the ultrasound-guided technique.
This report shows a case of diagnostic mistake in the fifth day after a TAP Block was made, which conditioned a second surgical intervention in a patient.
A 20 years old female patient, with a diagnosis of acute appendicitis was proposed to appendectomy. A TAP block was performed with ultrasound-guided technique and a total of 20 ml of ropivacaine 0,375% was injected. In the recovery room, no rescue analgesia was necessary. After 48 hours, asymptomatic and apyretic, was discharged home. In the 5th postoperatory day she visited the Emergency Department complaining of abdominal pain. She had fever and leukocytosis. An abdominal ultrasound reported a collection of a laminar liquid in the right flank of the abdominal wall, next to the surgical wound. Highly suspicious of an operatory wound abscess, the patient was reoperated, with the drainage of a clear, translucid liquid. A sample sent to microbiological culture turned negative. In the immediate postoperatory period, the diagnosis of an acute amigdalitis was performed.
Because the lack of experience with the TAP block, a bibliographic research was performed, without any explanation why the local anaesthetic wasn’t absorbed after 5 days, and the probable explanation was that it was deposited between fascias.
Therefore, we conclude that the diagnostic mistake was led by the lack of postoperatory vigilance and the lack of familiarization of the surgeon with this analgesic technique.