Scoliosis is a deformity of the spine resulting in a lateral curvature of the spine associated with rotation of the vertebrae and deformity of the rib cage.

A case of severe thoraco-lumbar kyphoscoliosis presented with infected inguinal swelling. On X-ray evaluation, the vertebral coloumn was grossly deviated with Cobbs angle >90°, thoracic cavity was small with crowding of ribs and lung fields were markedly reduced (baby lung). His resting respiratory rate was 30-34 breaths per minute and Pulmonary Function Tests revealed FEV1: 42%, FVC: 52%, PF: 27%and FEV25-75 : 45% with a restrictive pattern on flow-volume loop.

The patient was planned for surgical excision and debridement of swelling under regional anaesthesia. Attempts made to perform lumbar puncture using 23 G Quinke’s needle via midline, paramedian and Taylor’s approach were not successful. As the caudal space was obliterated and the landmarks were unidentifiable, both radiologically and clinically, the approach for caudal epidural block too failed. It was planned to perform a Transverses Abdominis Plane (TAP) block under sonographic guidance. Due to a small sized abdominal cavity of patient, the movements of ultrasound probe were restricted on abdomen. With an oblique orientation on abdominal wall, the muscle planes were identified and local anaesthetics administered in transverses abdominis plane. The surgery was completed successfully under TAP block, thus avoiding the potential risks of postoperative cardio-respiratory insufficiency following general anaesthesia.

In face of difficult neuroaxial blockade, TAP block can be utilized to provide surgical anesthesia for inguinal or superficial abdominal surgeries.