Essentials of Our Current Understanding

Abstract

Abdominal wall blocks rely on the spread of local anesthetic within musculofascial planes to anesthetize multiple small nerves or plexuses, rather than targeting specific nerve structures. Ultrasonography is primarily responsible for the widespread adoption of techniques including transversus abdominis plane and rectus sheath blocks, as well as the introduction of novel techniques such as quadratus lumborum and transversalis fascia blocks. These blocks are technically straightforward and relatively safe and reduce pain and opioid requirements in many clinical settings. The data supporting these outcomes, however, can be inconsistent because of heterogeneity of study design. The extent of sensory blockade is also somewhat variable, because it depends on the achieved spread of local anesthetic and the anatomical course of the nerves being targeted. The blocks mainly provide somatic analgesia and are best used as part of a multimodal analgesic regimen. This review summarizes the anatomical, sonographic, and technical aspects of the abdominal wall blocks in current use, examining the current evidence for the efficacy and safety of each.

Interfascial Plane Blocks

“…While the overall number of regional anesthesia techniques described in the ultrasound era has increased, no subset has grown as rapidly as the truncal interfascial plane blocks. 1 Although the concept is not new, the reliance on tactile "pops" and "clicks" to identify a needle placement and local anesthetic injection end point has been replaced with direct visualization of fascial planes and other relevant anatomy with ultrasound. 1 It seems like a new interfascial plane block is "invented" every month.…”

“…1 Although the concept is not new, the reliance on tactile "pops" and "clicks" to identify a needle placement and local anesthetic injection end point has been replaced with direct visualization of fascial planes and other relevant anatomy with ultrasound. 1 It seems like a new interfascial plane block is "invented" every month. Arguably, this started with the transversus abdominis plane (TAP) block and has been followed quickly by a series of TAP block derivations (eg, subcostal TAP), Pectoralis nerve (Pecs) I and Pecs II, serratus anterior and quadratus lumborum (QL) blocks, transversalis fascia block, and the erector spinae plane (ESP) block, among others.…”

Pectoral Fascial (PECS) I and II Blocks as Rescue Analgesia in a Patient Undergoing Minimally Invasive Cardiac Surgery

“…14 In contrast, Pecs blockade is a relatively simple fascial plane infiltration technique that seems to be associated with an excellent safety profile. 15 These blocks have been described in the setting of breast surgery to provide chest wall analgesia. When combined with general anesthesia for breast surgery, patients who received Pecs blocks had reduced pain scores, reduced opioid consumption for up to 12 hours, and improved sedation scores.…”

The comparison of ultrasonography guided transversus abdominis plane block and wound infiltration for pediatric inguinal hernia repair: Randomised clinical study

“…Plan blokları, ultrasonografi ile kolay uygulanabilir olması, komplikasyon oranlarının az oluşu, postoperatif yeterli analjezi sağlamaları ve opioid tüketi-mini azaltmalarıyla birlikte nöroaksiyel tekniklerin yerini almaya adaydır (9) . Trunkal bloklar olarak da adlandırılan plan blokları arasında, paravertebral, TAP, rektus sheath ve iliooinguinal/iliohipogastrik bloklar yer alırken son zamanlarda yine ultrasonografi eşliğinde yapılan quadratus lumborum ve PECs bloklar da bu kategoride yer almaktadır.…”