Local and Regional Anesthesia (Oct 2020)
Interfascial Plane Blocks and Laparoscopic Abdominal Surgery: A Narrative Review
Abstract
James Harvey Jones, Robin Aldwinckle Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, Sacramento, CA, USACorrespondence: James Harvey JonesDepartment of Anesthesiology and Pain Medicine, University of California Davis Medical Center, 4150 V Street, PSSB Suite 1200, Sacramento, CA 95817, USATel +1 (916) 734-5031Fax +1 (916) 734-7980Email [email protected]: Laparoscopic abdominal surgery has become a mainstay of modern surgical practice. Postoperative analgesia is an integral component of recovery following laparoscopic abdominal surgery and may be improved by regional anesthesia or intravenous lidocaine infusion. There is inconsistent evidence supporting the use of interfascial plane blocks, such as transversus abdominis plane (TAP) blocks, for patients undergoing laparoscopic abdominal surgery as evidenced by variable patterns of local anesthetic spread and conflicting results from studies comparing TAP blocks to local anesthetic infiltration of laparoscopic port sites and multimodal analgesia. Quadratus lumborum (QL) and erector spinae plane (ESP) blocks may provide greater areas of somatic analgesia as well as visceral analgesia, which may translate to more significant clinical benefits. Aside from the locations of the surgical incisions, it is unclear what other factors should be considered when choosing one regional technique over another or deciding to infuse lidocaine intravenously. We reviewed the current literature in attempt to clarify the roles of various regional anesthesia techniques for patients undergoing laparoscopic abdominal surgery and present one possible approach to evaluating postoperative pain.Keywords: transversus abdominis plane block, interfascial plane block, laparoscopic abdominal surgery, pain
