A patient with Chronic Kidney Disease (CKD) having history of Ischaemic Heart Disease (IHD) and Interstitial Lung Disease (ILD) was planned for CAPD catheter insertion with omentectomy. Usually CKD patients requiring general anaesthesia (GA) or spinal anaesthesia present a number of challenges to anaesthesiologist. This patient carried high risk for general anaesthesia due to interstitial lung disease. We managed this high risk case with bilateral Transversus Abdominis Plane (TAP) block and spinal fentanyl with very low dose bupivacaine hyperbaric 0.5% (0.5 ml) to reduce perioperative morbidity. Anaesthesia technique was adequate for conduct of surgery with minimal supplementation and no complications noted in the perioperative period. It was observed that this technique may be a feasible alternative option especially in patients who carry high risk of morbidity with general anaesthesia/spinal anaesthesia with regular dose of bupivacaine.

Keywords: Renal Insufficiency; Chronic; Peritoneal Dialysis; Continuous Ambulatory; Fentanyl; Spinal Anaesthesia; TAP Block.