title: Essentials of Our Current Understanding: Abdominal Wall Blocks.
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.
authors.affiliation: From the *Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; †Department of Anaesthesia, Clinical Sciences Institute, National University of Ireland, Galway, Ireland; ‡Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA; §Department of Anaesthesia, Guy's and St Thomas' Hospitals, London, United Kingdom; and ∥Department of Anesthesiology, Duke University Medical Center, Durham, NC.
authors.forename: Ki Jinn
authors.initials: KJ
authors.lastname: Chin
authors.forename: John G
authors.initials: JG
authors.lastname: McDonnell
authors.forename: Brendan
authors.initials: B
authors.lastname: Carvalho
authors.forename: Aidan
authors.initials: A
authors.lastname: Sharkey
authors.forename: Amit
authors.initials: A
authors.lastname: Pawa
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gadsden
mesh_terms: D034861:Abdominal Wall / Q000294:innervation*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D059925:Anatomic Landmarks; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D012684:Sensory Thresholds / Q000187:drug effects*; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local