Another Use of Continuous Transversus Abdominis Plane (TAP) Block in Trauma Patient: Pelvic Ring Fractures

Dear Editor: We would like to respond to the article published by Allcock et al. ⇓ describing the use of continuous transversus abdominis plane (TAP) block for analgesia in major abdominal surgery in a combat surgical environment. We report the successful use of an unconventional indication of this block in two patients who had painful traumatic pelvic ring fractures. The first patient was admitted to the intensive care unit following motor vehicle accidents with a stable pelvic fracture, left acetabular fracture, and right iliac wing and right ischium fractures. Immobilization was indicated. She had a severe left hip pain, 90/100 on the numerical rating scale (NRS). The NRS is a self-report assessment scale for patients using numbers (0 to 100) in order to rate the intensity of their pain. A multimodal analgesia with paracetamol, nefopam, and intravenous patient-controlled analgesia (PCA) with morphine was started. After morphine was administered (20 mg on 4 hours), the patient experienced drowsiness and bradypnea without demonstrable effective analgesia (NRS = 70/100). A left ultrasound-guided …