Background and Aims:
Transversus abdominis plane (TAP) block is a regional anesthesia technique frequently applied in lower abdominal surgeons. Cutaneous sensory blockage can be achieved in Th7-L1 dermatomes when the posterior TAP is applied, while the cutaneous sensory block is provided in Th10-Th12 dermatomes when the lateral TAP is applied. However, in both techniques, the L1 block often fails. The Transversal Fascia Plane (TFP) block selectively blocks Th12-L1 dermatomes. We would like to describe and present Ultrasound Guided TAP and TFP block application with single needle entry in this case.

Methods:
At age 48, the female patient was referred to ASA 2, who had multiple stone-dropping stories and planned open pyeloplasty. The patient's operation was performed under general anesthesia. Surgical incisions were made from the subcostal region to the inguinal region on an extensive basis. The operation lasted 195 minutes. Perioperative 1 g paracetamol and 20 mg tenoxicam were administered intravenously. It was decided to add regional techniques to the multimodal analgesia of the patient. The linear transducer was placed on the transverse plane of the abdomen. Lateral TAP block was applied (25 mL) and the needle was advanced in the same plane and TFP block was applied (15 mL).

Results
The sensory evaluation of the patient at the first postoperative hour revealed that the sensory block from Th6 to L1 was excellent. The patient did not have pain until the 9th hour postoperatively.

Conclusions:
The USG guided TAP + TFP block combination, performed by single needle insertion, provides an effective cutaneous abdominal sensorial block.

TRANSVERSALIS FASCIA PLANE BLOCK AND TRANSVERSUS ABDOMINIS PLANE BLOCK COMBINATION -PERFORMED WITH SINGLE NEEDLE INSERTION- PROVIDES IMPROVED ANALGESIA IN A PYELOPLASTY PATIENT