Transversus Abdominis Plane Block in the Emergency Department for Paracentesis: A Case Report.

Abdominal paracentesis is a key diagnostic and therapeutic intervention in patients with cirrhosis and ascites, yet it can be painful, especially in the presence of peritonitis. While local anesthetic infiltration is the conventional method for pain management, regional anesthesia techniques such as the ultrasound-guided transversus abdominis plane (TAP) block offer an effective, opioid-sparing alternative. We present the case of a 33-year-old woman with cirrhosis and suspected spontaneous bacterial peritonitis who underwent a large-volume paracentesis in the emergency department following a TAP block. The block provided effective somatic analgesia, improved procedural tolerance, and minimized opioid use. The case highlights the utility of TAP blocks as part of a multimodal pain management strategy for paracentesis in select emergency department patients. Broader implementation may enhance patient comfort, reduce the need for systemic analgesia, and provide valuable procedural training opportunities for emergency physicians.