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Background and Aims Anorectal malformations such as atresia ani are congenital anomalies that necessitate early surgical intervention, often in the form of a transverse colostomy to divert fecal flow. This case aims to highlight the use of ultrasound-guided TAP block as an elective anesthetic technique for a transverse colostomy in a 2-day-old infant with atresia ani. The goal is to demonstrate its effectiveness in providing adequate perioperative analgesia while minimizing the risk associated with general anesthesia in neonates.Methods A 2-day-old full-term male neonate, weighing 2,3 kg, was referred to the pediatric surgery unit with a diagnosis of atresia ani following the absence of meconium passage since birth. Physical examination revealed abdominal distention and absence of an anal opening. The infant was otherwise active, with no signs of additional congenital anomalies or dysmorphic features. Vital signs were stable, with a heart rate 152 BPM, respiratory rate of 42 breaths/min, blood pressure of 68/40 mmHg, and oxygen saturation of 98% on room air.Results The use of an ultrasound-guidede TAP block as the primary anesthetic technique in neonates is increasingly recognized as a safe and effective alternative to general anesthesia, particularly in high-risk or low-weight infants. In this case, a Tap block provided sufficient intraoperative anesthesia and postoperative analgesia for a transverse colostomy in a 2-day-old neonate with anorectal malformation, thereby avoiding the systemic effects of inhalation agents and opioids.Abstract P105 Figure 1E-PosterConclusions Ultrasound-guided TAP block proves to be a safe and effective anesthetic technique for neonates undergoing abdominal surgeries such as transverse colostomy for anorectal malformations. It provides adequate perioperative analgesia, minimizes the need for systemic opioids, and reduces the risk associated with general anesthesia in high-risk, low-weight infants. This case demonstrates that TAP block can be a valuable tool in neonatal anesthesia, promoting better recovery and lessening the adverse effects typically seen with conventional anesthetic approaches.