January's Question of the Month is written by:    

Elizabeth O'Brien, MD
Pediatric Anesthesiology Fellow
Department of Anesthesiology and Critical Care
Children’s Hospital of Philadelphia


An 8-year-old female with a history of a cleft lip and palate status post staged primary repairs of both defects presents for an alveolar cleft graft. The surgical team intends to use a pyramidal bone block from the anterior iliac crest for the graft site. The patient reports hives with morphine and a history of postoperative nausea/vomiting. As part of an opioid-sparing multimodal analgesic plan, you offer to place a transversalis fascia plane block for post-op pain control. Identify the location for local anesthetic deposition for a successful block:

Figure 1