823 - A TAP Block to Cure Chronic Abdominal Pain and Refractory Belching

Case Diagnosis: A transverse abdominis plane (TAP) block is a common block that anesthetizes nerves that supply the anterior abdominal wall, spanning from T6 to L1. TAP blocks are quick, simple, and safe. TAP blocks reduce opioid utilization. Clinically and in the literature, TAP blocks are primarily used for acute pain; however, we present a novel use for the treatment of chronic pain and refractory belching.

Case Description: We present a middle-aged male who underwent a left indirect inguinal hernia repair with mesh. No immediate post-operative complications were reported. On postoperative day two, he began experiencing upper abdominal pain, food intolerance, and excessive belching occurring every 3 minutes. Initially, symptoms were attributed to gas-bloat syndrome. Conservative management was recommended. After no improvement, a CT scan was performed, revealing an abnormal loop of bowel near the hernia repair site. A delayed takeback operation occurred. A small bowel segment adhered to the mesh’s underside was discovered.

Despite surgical correction and subsequent consultations with specialists, diagnostic tests, and therapeutic interventions over several years, symptoms persisted. He suffered unintended weight loss, benzodiazepine addiction, and a significant decline in his ability to perform activities of daily living (ADLs). This affected his employment and social life, leading to the development of various mental health conditions.

Discussions: Symptoms were attributed to nerve irritation. No definitive diagnosis was reached. A previous TAP block had provided relief. The patient pursued a series of 3 TAP blocks. Following the first block, he reported a 50% reduction in symptoms, followed by an additional 40%, with the outcome of the third block pending follow-up. His current pain level is tolerable, nutritional intake is improving, and belching frequency is every three hours.

Conclusions: Our study is noteworthy in demonstrating that TAP blocks can be effective in treating chronic pain and refractory belching and improving function and quality of life.