Ultrasound-Guided transversus abdominis plane block as an elective anesthetic technique for transverse colostomy in a 2-Day old infant with atresia ANI

Anorectal malformations such as atresia ani are congenital anomalies that necessitate early surgical intervention, often in the form of a transverse colostomy to divert fecal flow.In neonates, choosing an anesthetic technique that minimizes systemic impact while providing effective pain control is critical due to their physiological vulnerability.Ultrasound-guided Transversus Abdominis Plane (TAP) block has emerged as a valuable regional anesthesia technique, offering safe and reliable analgesia with minimal respiratory and hemodynamic compromise-making it an appealing option in high-risk neonatal cases.Case Presentation A 2-day-old full-term male neonate (2.3 kg) with anorectal malformation (atresia ani) presented with abdominal distension and absence of meconium passage since birth.Stable vital signs and normal preoperative labs, including coagulation profile, supported surgical intervention.Due to the high anesthetic risk associated with general anesthesia in low-weight neonates, an ultrasound-guided bilateral Transversus Abdominis Plane (TAP) block using 0.2% ropivacaine (0.5 mL/kg per side) was performed as the primary anesthetic technique for a transverse colostomy.Intraoperatively, the infant remained hemodynamically stable, with no need for conversion to general anesthesia.Postoperative recovery was smooth with minimal pain (FLACC score 0-1), no opioids required, and discharge from NICU on day 3 in good condition.Ultrasound-guided Transversus Abdominis Plane (TAP) block proves to be a safe and effective anesthetic technique for neonates undergoing abdominal surgeries such as transverse colostomy for anorectal malformations.It provides adequate perioperative analgesia, minimizes the need for systemic opioids, and reduces the risks associated with general anesthesia in high-risk, low-weight infants.This case demonstrates that TAP block can be a valuable tool in neonatal anesthesia, promoting better recovery and lessening the adverse effects typically seen with conventional anesthetic approaches.