To the Editor: Until recently, we have used transversus abdominis plane (TAP) block in combination with morphine patient-controlled analgesia (PCA) postoperatively in renal transplant recipients. However, as a result of the long duration of surgery, although TAP block decreases the need for intraoperative analgesia, the analgesic effect of the block fades postoperatively. To prolong the analgesic effect, we used a continuous infusion of local anesthetic via the TAP catheter, placed preoperatively under ultrasound guidance. The main problems experienced with this technique were technical: difficulty feeding the catheter into the TAP space; leakage of local anesthetic through the orifices at the sides of the catheter; a relatively low success rate (50%) in terms of catheter placement and, consequently, analgesic effect; and possible interference with the surgical field.

We have subsequently developed a technique whereby the catheter is placed into the TAP plane by the surgeon under direct vision: the surgical dissection creates a small space (1 cm wide 3–5 cm long) between the transverse abdominis and internal oblique muscles in the lateral side of the wound. The tip of a 16-gauge epidural needle (Portex™ Epidural Minipack, Smiths Medical Australasia Pty, Brisbane, Australia) is inserted through the dissected space, the internal and external oblique muscles, the subcutaneous tissue and the skin, passing through the skin approximately 2 cm from the upper end of the