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Background and Aims: The purpose of this study was to compare the analgesic efficacy of ultrasonography-guided transversus abdominis plane (TAP) blocks with local port site infiltration in children undergoing laparoscopic surgeries. Methods: After ethics committee approval and informed consent, 92 children aged 2–12 years posted for laparoscopic surgeries were randomly divided into Group T and Group L. Port site infiltration was performed in Group L by the surgeon at the time of port placement and end of surgery with 0.4mL/kg of 0.25% bupivacaine. Bilateral TAP block was performed in Group T after induction of anaesthesia, under ultrasonographic guidance with a Logiq E7 GE portable ultrasound unit and a linear 5–10 MHz probe. A 22G hypodermic needle and 0.4 mL/kg of 0.25% bupivacaine were used on each side for the TAP block. The parameters recorded were intraoperative haemodynamics, opioid requirements, postoperative pain scores and the need for rescue analgesia in the first 6 h postoperatively. Results: The median (interquartile range) pain scores were significantly lower in the TAP block group than the local infiltration group at 10 min [2 (0–2.5) vs 2 (3–4); P = 0.011], 30 min [1.5 (0–3) vs 3 (2–5);P < 0.001], 1 h [1.5 (0–2) vs 2 (2–3);P < 0.001] and 2 h [2 (0–2) vs 2 (1.5–2.5); P = 0.010] postoperatively. The need for intraoperative opioids and rescue analgesia was also significantly lower in the TAP block group ( P < 0.001). Conclusion: TAP block is superior to local infiltration for intra- and immediate postoperative analgesia in paediatric laparoscopic surgeries.

An 86−year−old man presented with a 3− day history of abdominal distension, epi− gastric pain, and vomiting. Computed to− mography showed gastric distension, with part of the gastric body herniating into the thoracic cavity, and a paraesoph− ageal hernia. These findings were consis− tent with a mesenteroaxial gastric volvu− lus (l " Figure 1). The patient was signifi− cantly dehydrated and further tests re−

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