Abstract
Purpose of Review
The purpose of this review is to synthesize recent literature investigating the use of regional anesthesia for minimally invasive surgery.
Recent Findings
Recent studies investigating the use of newer peripheral nerve blocks such as erector spinae plane (ESP) and quadratus lumborum (QL) block are very limited.
Summary
Evidence supporting the use of peripheral nerve blockade in laparoscopic or robotic surgery is very limited and of low-moderate quality. While transverse abdominal plane (TAP) block may decrease opioid and pain scores after laparoscopic cholecystectomy, bariatric surgery, and colorectal surgery, the benefit of the block in the presence of multimodal analgesia remains to be clarified. Unilateral paravertebral block may be beneficial for percutaneous nephrolithotomy. ESP and rectus sheath blockade may enhance analgesia in laparoscopic surgery, but the magnitude of this benefit may not be clinically relevant. Limited evidence supports the use of QL block in laparoscopic urologic surgery. There is insufficient recent evidence to support the use of TAP or QL block for laparoscopic gynecologic surgery.
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References
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Muaddi H, Hafid ME, Choi WJ, et al. Clinical outcomes of robotic surgery compared to conventional surgical approaches (laparoscopic or open): a systematic overview of reviews. Ann Surg. 2021;273(3):467–73.
Sheetz KH, Claflin J, Dimick JB. Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open. 2020;3(1):e1918911.
Lemoine A, Witdouck A, Beloeil H, Bonnet F, Anaesthesia PWGOTESOR, Pain T. PROSPECT guidelines update for evidence-based pain management after prostatectomy for cancer. Anaesth Crit Care Pain Med. 2021;40(4):100922.
• El-Boghdadly K, Wolmarans M, Stengel AD, et al. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks. Reg Anesth Pain Med. 2021;46(7):571-580. This study describes how nomenclature for abdominal wall blocks should be standardized to prevent confusion when assessing potential impact and clinical relevance of these regional anesthetic techniques.
Grape S, Kirkham KR, Akiki L, Albrecht E. Transversus abdominis plane block versus local anesthetic wound infiltration for optimal analgesia after laparoscopic cholecystectomy: a systematic review and meta-analysis with trial sequential analysis. J Clin Anesth. 2021;75:110450.
Bacal V, Rana U, McIsaac DI, Chen I. Transversus abdominis plane block for post hysterectomy pain: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2019;26(1):40–52.
Houben AM, Moreau AJ, Detry OM, Kaba A, Joris JL. Bilateral subcostal transversus abdominis plane block does not improve the postoperative analgesia provided by multimodal analgesia after laparoscopic cholecystectomy: a randomised placebo-controlled trial. Eur J Anaesthesiol. 2019;36(10):772–7.
• Shim JW, Ko J, Bae JH, et al. Pre-emptive multimodal analgesic bundle with transversus abdominis plane block enhances early recovery after laparoscopic cholecystectomy. Asian J Surg. 2021. This article stands out as it reflects current trends to move away from using subjective pain scores or comparing opioid consumption irrespective of potential opioid tolerance and instead evaluate quality of recovery or functional outcomes.
Aamir MA, Sahebally SM, Heneghan H. Transversus abdominis plane block in laparoscopic bariatric surgery—a systematic review and meta-analysis of randomized controlled trials. Obes Surg. 2021;31(1):133–42.
Foldi M, Soos A, Hegyi P, et al. Transversus abdominis plane block appears to be effective and safe as a part of multimodal analgesia in bariatric surgery: a meta-analysis and systematic review of randomized controlled trials. Obes Surg. 2021;31(2):531–43.
Hamid HKS, Ahmed AY, Saber AA, Emile SH, Ibrahim M, Ruiz-Tovar J. Transversus abdominis plane block using a short-acting local anesthetic reduces pain and opioid consumption after laparoscopic bariatric surgery: a meta-analysis. Surg Obes Relat Dis. 2020;16(9):1349–57.
Ruiz-Tovar J, Gonzalez G, Sarmiento A, et al. Analgesic effect of postoperative laparoscopic-guided transversus abdominis plane (TAP) block, associated with preoperative port-site infiltration, within an enhanced recovery after surgery protocol in one-anastomosis gastric bypass: a randomized clinical trial. Surg Endosc. 2020;34(12):5455–60.
Mittal T, Dey A, Siddhartha R, Nali A, Sharma B, Malik V. Efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic gastric sleeve resection: a randomized single blinded case control study. Surg Endosc. 2018;32(12):4985–9.
Emile SH, Abdel-Razik MA, Elbahrawy K, et al. Impact of ultrasound-guided transversus abdominis plane block on postoperative pain and early outcome after laparoscopic bariatric surgery: a randomized double-blinded controlled trial. Obes Surg. 2019;29(5):1534–41.
Saber AA, Lee YC, Chandrasekaran A, et al. Efficacy of transversus abdominis plane (TAP) block in pain management after laparoscopic sleeve gastrectomy (LSG): a double-blind randomized controlled trial. Am J Surg. 2019;217(1):126–32.
Wong KA, Cabrera AG, Argiroff AL, et al. Transversus abdominis plane block with liposomal bupivacaine and its effect on opiate use after weight loss surgery: a randomized controlled trial. Surg Obes Relat Dis. 2020;16(7):886–93.
Hain E, Maggiori L, Prost AlDJ, Panis Y. Transversus abdominis plane (TAP) block in laparoscopic colorectal surgery improves postoperative pain management: a meta-analysis. Colorectal Dis. 2018;20(4):279–287.
Oh TK, Lee SJ, Do SH, Song IA. Transversus abdominis plane block using a short-acting local anesthetic for postoperative pain after laparoscopic colorectal surgery: a systematic review and meta-analysis. Surg Endosc. 2018;32(2):545–52.
Zhao Y, Zhang HY, Yuan ZY, et al. Analgesic efficacy of postoperative bilateral, ultrasound-guided, posterior transversus abdominis plane block for laparoscopic colorectal cancer surgery: a randomized, prospective, controlled study. BMC Anesthesiol. 2021;21(1):107.
Haruethaivijitchock P, Ng JL, Taksavanitcha G, et al. Postoperative analgesic efficacy of modified continuous transversus abdominis plane block in laparoscopic colorectal surgery: a triple-blind randomized controlled trial. Tech Coloproctol. 2020;24(11):1179–87.
Fields AC, Weiner SG, Maldonado LJ, et al. Implementation of liposomal bupivacaine transversus abdominis plane blocks into the colorectal enhanced recovery after surgery protocol: a natural experiment. Int J Colorectal Dis. 2020;35(1):133–8.
Hong KY, Kim DK, Park HJ, et al. Analgesic efficacy of preemptive transversus abdominis plane block in patients undergoing laparoscopic colorectal cancer surgery. J Clin Med. 2020;9(5).
Zhou H, Ma X, Pan J, et al. Effects of transversus abdominis plane blocks after hysterectomy: a meta-analysis of randomized controlled trials. J Pain Res. 2018;11:2477–89.
Tan X, Fu D, Feng W, Zheng X. The analgesic efficacy of paravertebral block for percutaneous nephrolithotomy: a meta-analysis of randomized controlled studies. Medicine (Baltimore). 2019;98(48):e17967.
Yayik AM, Ahiskalioglu A, Demirdogen SO, Ahiskalioglu EO, Alici HA, Kursad H. Ultrasound-guided low thoracic paravertebral block versus peritubal infiltration for percutaneous nephrolithotomy: a prospective randomized study. Urolithiasis. 2020;48(3):235–44.
Hatipoglu Z, Gulec E, Turktan M, et al. Comparative study of ultrasound-guided paravertebral block versus intravenous tramadol for postoperative pain control in percutaneous nephrolithotomy. BMC Anesthesiol. 2018;18(1):24.
Baldea KG, Patel PM, Delos Santos G, et al. Paravertebral block for percutaneous nephrolithotomy: a prospective, randomized, double-blind placebo-controlled study. World J Urol. 2020;38(11):2963–9.
Daghmouri MA, Akremi S, Chaouch MA, et al. Bilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. Pain Pract. 2021;21(3):357–65.
Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z. Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical trial. J Clin Anesth. 2018;49:101–6.
Kwon HM, Kim DH, Jeong SM, et al. Does erector spinae plane block have a visceral analgesic effect?: a randomized controlled trial. Sci Rep. 2020;10(1):8389.
Kang R, Chin KJ, Gwak MS, et al. Bilateral single-injection erector spinae plane block versus intrathecal morphine for postoperative analgesia in living donor laparoscopic hepatectomy: a randomized non-inferiority trial. Reg Anesth Pain Med. 2019.
Hamid HKS, Ahmed AY, Alhamo MA, Davis GN. Efficacy and safety profile of rectus sheath block in adult laparoscopic surgery: a meta-analysis. J Surg Res. 2021;261:10–7.
Kim WJ, Mun JY, Kim HJ, et al. Surgical rectus sheath block combined with multimodal pain management reduces postoperative pain and analgesic requirement after single-incision laparoscopic appendectomy: a retrospective study. Int J Colorectal Dis. 2021;36(1):75–82.
Cho S, Kim YJ, Jeong K, Moon HS. Ultrasound-guided bilateral rectus sheath block reduces early postoperative pain after laparoscopic gynecologic surgery: a randomized study. J Anesth. 2018;32(2):189–97.
Kinjo Y, Kurita T, Fujino Y, Kawasaki T, Yoshino K, Hachisuga T. Evaluation of laparoscopic-guided rectus sheath block in gynecologic laparoscopy: a prospective, double-blind randomized trial. Int J Surg. 2019;62:47–53.
Kitamura N, Iida H, Maehira H, et al. Postoperative analgesic effect of ultrasound-guided rectus sheath block and local anesthetic infiltration after laparoscopic cholecystectomy: results of a prospective randomized controlled trial. Asian J Endosc Surg. 2021.
• Dam M, Hansen C, Poulsen TD, et al. Transmuscular quadratus lumborum block reduces opioid consumption and prolongs time to first opioid demand after laparoscopic nephrectomy. Reg Anesth Pain Med. 2021;46(1):18-24. We highlight this well-designed randomized controlled trial for standardizing a multimodal analgesic regimen in both the block and control groups. This study design helps elucidate the true value of regional anesthesia in the era of enhanced recovery after surgery.
Zhu M, Qi Y, He H, Lou J, Pei Q, Mei Y. Analgesic effect of the ultrasound-guided subcostal approach to transmuscular quadratus lumborum block in patients undergoing laparoscopic nephrectomy: a randomized controlled trial. BMC Anesthesiol. 2019;19(1):154.
Kwak KH, Baek SI, Kim JK, Kim TH, Yeo J. Analgesic effect of ultrasound-guided preoperative unilateral lateral quadratus lumborum block for laparoscopic nephrectomy: a randomized, double-blinded, controlled trial. J Pain Res. 2020;13:1647–54.
Okmen K, Okmen BM. Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial. Korean J Anesthesiol. 2020;73(1):44–50.
Dam M, Hansen CK, Poulsen TD, et al. Transmuscular quadratus lumborum block for percutaneous nephrolithotomy reduces opioid consumption and speeds ambulation and discharge from hospital: a single centre randomised controlled trial. Br J Anaesth. 2019;123(2):e350–8.
Okmen K, Metin Okmen B, Sayan E. Ultrasound-guided lateral versus posterior quadratus lumborum block for postoperative pain after laparoscopic cholecystectomy: a randomized controlled trial. Turk J Surg. 2019;35(1):23–9.
Pang M, Sun G, Yao W, et al. Ultrasound-guided transmuscular quadratus lumborum block reduced postoperative opioids consumptions in patients after laparoscopic hepatectomy: a three-arm randomized controlled trial. BMC Anesthesiol. 2021;21(1):45.
Dewinter G, Coppens S, Van de Velde M, et al. Quadratus lumborum block versus perioperative intravenous lidocaine for postoperative pain control in patients undergoing laparoscopic colorectal surgery: a prospective, randomized, double-blind controlled clinical trial. Ann Surg. 2018;268(5):769–75.
Hansen C, Dam M, Nielsen MV, et al. Transmuscular quadratus lumborum block for total laparoscopic hysterectomy: a double-blind, randomized, placebo-controlled trial. Reg Anesth Pain Med. 2021;46(1):25–30.
Fujimoto H, Irie T, Mihara T, Mizuno Y, Nomura T, Goto T. Effect of posterior quadratus lumborum blockade on the quality of recovery after major gynaecological laparoscopic surgery: a randomized controlled trial. Anaesth Intensive Care. 2019;47(2):146–51.
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Alberto Ardon declares no relevant conflicts of interest. Nadia Hernandez has received honoraria from Butterfly Network, Inc.
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Ardon, A., Hernandez, N. The Use of Peripheral Nerve Blockade in Laparoscopic and Robotic Surgery: Is There a Benefit?. Curr Pain Headache Rep 26, 25–31 (2022). https://doi.org/10.1007/s11916-022-01002-4
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DOI: https://doi.org/10.1007/s11916-022-01002-4