transversus abdominis plane ( tap ) block is a newer regional technique available . although there is emerging evidence proving the efficacy of tap blocks , there is limited literature on use of tap catheters in pediatric patients . we share the pain management of two children , in whom tap catheters were inserted . a right transverse supraumbilical incision was taken for surgical exposure , intraoperative course was uneventful . at closure , a 19 g tuohy needle was placed in between transversus abdominis and internal oblique muscle under ultrasound guidance [ figure 1 ] . a 21 g epidural catheter was threaded through the tuohy 's needle to a depth of 23 cm . bupivacaine , 5cc of 0.25% , was given through the catheter after closure and 8 hourly . coanalgesic included 100 mg of paracetamol and 80 mg of ibuprofen oral every 8 hourly . the child was pain - free and catheter was removed at 72 h. the site was healthy and pain medications continued on a need basis . schematic diagram showing the position of ultrasound probe ( p ) , direction of needle ( n ) with respect to the incision and the relevant ultrasound anatomy . umb = umbilicus , xip = xiphisternum , sc = subcutaneous tissue , eo = external oblique muscle , io = internal oblique muscle , ta = transversus abdominis muscle , pc = peritoneal cavity . the needle is inserted by  in plane  technique a 4-year - old , 10 kg , child was posted for urgent exploratory laparotomy for suspected infection of mesenteric cyst . in view of high white blood cell count ( 21.99  10/l ) and elevated c - reactive protein levels ( 18.4 mg / dl ) , epidural analgesia was deferred . closure , due to unavailability of ultrasound , the surgical team was asked to dissect the plane between transversus abdominis and internal oblique and a 21 g catheter was placed in the plane under vision [ figure 2 ] . bupivacaine , 6 ml of 0.25% , was given through the catheter , 8 hourly along with oral ibuprofen and paracetamol . pain relief was adequate and catheter removed at 48 h. surgically placed catheter ( c ) , the plane between transversus abdominis muscle and internal oblique is surgically dissected and catheter is placed under direct vision using the metallic tuohy needle ( n ) . a right transverse supraumbilical incision was taken for surgical exposure , intraoperative course was uneventful . at closure , a 19 g tuohy needle was placed in between transversus abdominis and internal oblique muscle under ultrasound guidance [ figure 1 ] . a 21 g epidural catheter was threaded through the tuohy 's needle to a depth of 23 cm . bupivacaine , 5cc of 0.25% , was given through the catheter after closure and 8 hourly . coanalgesic included 100 mg of paracetamol and 80 mg of ibuprofen oral every 8 hourly . the child was pain - free and catheter was removed at 72 h. the site was healthy and pain medications continued on a need basis . schematic diagram showing the position of ultrasound probe ( p ) , direction of needle ( n ) with respect to the incision and the relevant ultrasound anatomy . umb = umbilicus , xip = xiphisternum , sc = subcutaneous tissue , eo = external oblique muscle , io = internal oblique muscle , ta = transversus abdominis muscle , pc = peritoneal cavity . a 4-year - old , 10 kg , child was posted for urgent exploratory laparotomy for suspected infection of mesenteric cyst . in view of high white blood cell count ( 21.99  10/l ) and elevated c - reactive protein levels ( 18.4 mg / dl ) , epidural analgesia was deferred . closure , due to unavailability of ultrasound , the surgical team was asked to dissect the plane between transversus abdominis and internal oblique and a 21 g catheter was placed in the plane under vision [ figure 2 ] . bupivacaine , 6 ml of 0.25% , was given through the catheter , 8 hourly along with oral ibuprofen and paracetamol . pain relief was adequate and catheter removed at 48 h. surgically placed catheter ( c ) , the plane between transversus abdominis muscle and internal oblique is surgically dissected and catheter is placed under direct vision using the metallic tuohy needle ( n ) . use of ultrasound guidance has increased the safety and efficacy of blocks and is responsible for increased use of regional techniques . few catheters , including the tap catheters , can be placed under vision by the surgeons . spillage of local anesthetic from the dissected planes is a possibility with this technique though this has not been formally studied . guidance on best volume and dose for the tap block is lacking . a few studies advocate use of high volume of local anesthetic through these catheters . we used intermittent boluses of high volumes of local anesthetic ( 0.60.7 ml / kg ) through the tap catheter , ensuring that the maximum permissible level of bupivacaine is not exceeded . in adults , continuous abdominal catheters have found a place for postoperative pain management , when epidural analgesia is contraindicated . at present , the use of tap catheters by pediatric anesthesiologist is limited though there are diverse clinical scenarios when these catheters may be of benefit . contraindication of neuraxial blockade and septic patients are the two scenarios we have reported . in conclusion , tap catheters are effective analgesia technique for laparotomies with transverse incision in pediatric patients .
regional techniques provides excellent post operative pain relief in pediatric patients . 
 transversus abdominis plane ( tap ) block is a newer regional technique available . though there is emerging evidence proving the efficacy of tap blocks , 
 there is limited literature on use of tap catheters in pediatric patients . 
 tap catheters were placed in two children following laparotomy with transverse incisions and in both epidural was avoided , with good post operative pain relief . 
 ultrasound guidance was used in one child , while in the other the catheter was placed under direct vision after dissection of the plane between transversus abdominis and internal oblique . 
 intermittent boluses of high volumes of local anesthetic ( 0.6 - 0.7 ml / kg ) were used through the tap catheter , ensuring that the maximum permissible level of bupivacaine was not exceeded . in adults , 
 continuous abdominal catheters have found a place for post - operative pain management , when epidural analgesia is contraindicated . at present , the use of tap catheters by pediatric anesthesiologists is limited , though there exists diverse clinical scenarios when these catheters may be of benefit . 
 contraindication of neuraxial blockade and septic patients are the two scenarios we have reported . in conclusion , 
 tap catheters are effective analgesia technique for laparotomies with transverse incision in pediatric patients .