Peripheral nerve blocks have a unique role in postcesarean delivery multimodal analgesia regimens. In this review article, options for peripheral nerve blocks for cesarean delivery analgesia will be reviewed, specifically paravertebral, transversus abdominis plane, quadratus lumborum, iliohypogastric and ilioinguinal, erector spinae, and continuous wound infiltration blocks. Anatomy, existing literature evidence, and specific areas in need of future research will be assessed. Considerations for local anesthetic toxicity, and for informed consent for these modalities in the context of emergency cesarean deliveries, will be presented.
(Reg Anesth Pain Med. 2020;45:52–62)Peripheral nerve blocks are used in nonobstetrical surgery as part of a multimodal analgesic strategy. These blocks have been associated with reduced opioid requirements, better quality of recovery, and reduced hospital utilization. Yet, peripheral nerve blocks are not routinely performed for cesarean delivery. This review article discussed several peripheral nerve block options for cesarean delivery, including lumbar sympathetic paravertebral (PVB), transversus abdominis plane (TAP), quadratus lumborum (QL), ilioinguinal-iliohypogastric (II-IH), continuous wound infiltration (CWI), and erector spinae plane blocks.
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