Peri-incisional catheters through open surgical wound in converted nephrectomies: A novel modification of transverse abdominis plane block

We have placed dual peri-incisional TAP catheters through the surgical wound in 3 cases. A 16G Tuohy needle is introduced 2 inch above outer edge of the wound on either side; the needle is passed between the internal oblique and transversus abdominis muscle/ aponeurosis, guided by the surgeon. As the needle comes out of the wound, we thread the catheter till it comes out of the distal end of needle [Figure 1]. The needle is withdrawn and the catheter is brought out for 1–2 cm and flushed with 5 cc saline. Any pericatheter leak is checked and suture fixation is done. Fixation is reinforced with a catheter clamp [Figure 2]. Postoperatively, the patient receives 0.1% bupivacaine infusions at 6–8 ml/h for 3 days and morphine, a patient-controlled analgesia as rescue. The average pain scores on day 1 were 3/10 at rest and 5/10 on coughing.