Transversus abdominis plane nerve blocks in the concept of enhanced recovery after a cesarean section

DOI

https://dx.doi.org/10.18565/aig.2022.271

Kornienko A.V., Nitchenko A.V., Troshin P.V., Pyregov A.V.
Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia

One of the main elements of the strategy of fast track surgery or enhanced recovery after surgery (ERAS) is to activate a patient in the early postoperative period after any surgery; however, this is not achievable without pain control in the early postoperative period. In this case, cesarean section is no exception. Non-optimal analgesia is associated with delayed functional recovery, delayed mobilization, which may increase the risk of thromboembolic events, delay early mother-infant contact, and increase the risk of postpartum depression. The modern approach to adequate analgesia includes the principle of multimodality, which has an impact on all components of a nociceptive impulse. Epidural anesthesia, as well as abdominis neurofascial plane nerve block (quadratus lumborum (QL) or transversus abdominis plane (TAP) block, erector spinae plane (ESP) block), which is a variety of peripheral or regional block of the nerves involved in the innervation of the anterior abdominal wall, play a unique role in multimodal pain management regimens after a cesarean section, and also allow the amount of opioids to be reduced, which is an important element of the Fast Track concept.
Conclusion: QL block and ESP block can become promising methods for regional anesthesia after TAP block. Further randomized controlled safety trials are needed to identify the risk of the toxicity and efficacy of abdominal wall blocks and their impact on the visceral component of pain after a caesarean section.

Authors' contributions: Pyregov A.V. – concept development, analysis and interpretation of the findings, text preparation and editing, approval of the final version of the article; Kornienko A.V., Troshin P.V., Nitchenko A.V. – concept development, data collection, analysis and interpretation of the findings, text preparation and editing, approval of the final version of the article.
Conflicts of interest: The authors declare that there are no manifest and potential conflicts of interest related to the publication of this article.
Funding: The investigation has not been sponsored.
For citation: Kornienko A.V., Nitchenko A.V., Troshin P.V., Pyregov A.V. Transversus abdominis plane nerve blocks in the concept of enhanced recovery after a cesarean section.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (3): 29-34 (in Russian)
https://dx.doi.org/10.18565/aig.2022.271

Fast Track Surgery

ERAS

TAP (transversus abdominis plane) block

ilioinguinal nerve block

iliohypogastric nerve block

ilioinguinal/iliohypogastric block

cesarean section

postoperative pain relief

Full text (in Russian)

Lassen K., Soop M., Nygren J., Cox P.B.W., Hendry P.O., Spies C. et al.; Enhanced Recovery After Surgery (ERAS) Group. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch. Surg. 2009; 144(10): 961-9.https://dx.doi.org/10.1001/archsurg.2009.170.
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br. J. Anaesth. 1997; 78(5): 606-17. https://dx.doi.org/10.1093/bja/78.5.606.
Visser G.H.A., Ayres-de-Campos D., Barnea E.R., de Bernis L., Di Renzo G.C., Escobar Vidarte M.F. et al. FIGO position paper: how to stop the caesarean section epidemic. Lancet. 2018; 392(10155): 1286-7. https://dx.doi.org/10.1016/S0140-6736(18)32113-5.
Betrán A.P., Ye J., Moller A.-B., Zhang J., Gülmezoglu A.M., Torloni M.R. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS One. 2016; 11(2): e0148343. https://dx.doi.org/10.1371/journal.pone.0148343.
Доброхотова Ю.Э., Кузнецов П.А., Копылова Ю.В., Джохадзе Л.С. Кесарево сечение: прошлое и будущее. Гинекология. 2015; 17(3): 64-7. [Dobrokhotova Yu.E., Kuznetsov P.A., Kopylova Yu.V., Dzhokhadze L.S. Caesarean section: past and future. Gynecology. 2015; 17(3): 64-7.(in Russian)].
Милованов А.П., ред. Анализ причин материнской смертности. Руководство для врачей. М.; 2008. 228с. [Electronic resource]. Доступно по: https://www.elibrary.ru/item.asp?id=12918129 Активна на: 20.01.2023. [Milovanov A.P., ed. Analysis of the causes of maternal mortality: A guide for doctors. Moscow; 2008. 228p. Electronic resource]. Available at: https://www.elibrary.ru/item.asp?id=12918129 Accessed 20.01.2023.(in Russian)].
Государственный комитет Российской Федерации по статистике (Госкомстат России). Демографический ежегодник Российской Федерации: статистический сборник. [Electronic resource]. Доступно по: https://search.rsl.ru/ru/record/01009582218 Активна на: 20.01.2023. [State Statistics Committee of the Russian Federation (Goskomstat of Russia). The demographic yearbook of the Russia. [Electronic resource]. Available at: https://search.rsl.ru/ru/record/01009582218 Accessed 20.01.2023.(in Russian)].
Gerbershagen H.J., Aduckathil S., van Wijck A.J.M., Peelen L.M., Kalkman C.J., Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013; 118(4): 934-44. https://dx.doi.org/10.1097/ALN.0b013e31828866b3.
Whiteside J.L., Barber M.D., Walters M.D., Falcone T. Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions. Am. J. Obstet. Gynecol. 2003; 189(6): 1574-8; discussion 1578. https://dx.doi.org/10.1016/s0002-9378(03)00934-7.
Gizzo S., Andrisani A., Noventa M., Di Gangi S., Quaranta M., Cosmi E. et al. Caesarean section: could different transverse abdominal incision techniques influence postpartum pain and subsequent quality of life? A systematic review. PLoS One. 2015; 10(2): e0114190. https://dx.doi.org/10.1371/journal.pone.0114190.
Wilson R.D., Caughey A.B., Wood S.L., Macones G.A., Wrench I.J., Huang J. et al. Guidelines for intraoperative care in cesarean delivery: enhanced recovery after surgery society recommendations (Part 2). Am. J. Obstet. Gynecol. 2018; 219(6): 533-44. https://dx.doi.org/10.1016/j.ajog.2018.08.006.
Verma K., Malawat A., Jethava D., Jethava D.D. Comparison of transversus abdominis plane block and quadratus lumborum block for post-caesarean section analgesia: a randomised clinical trial. Indian J. Anaesth. 2019; 63(10): 820-6. https://dx.doi.org/10.4103/ija.IJA_61_19.
Blanco R., Ansari T., Riad W., Shetty N. Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery: a randomized controlled trial. Reg. Anesth. Pain Med. 2016; 41(6): 757-62. https://dx.doi.org/10.1097/AAP.0000000000000495.
Huffnagle H.J., Norris M.C., Leighton B.L., Arkoosh V.A. Ilioinguinal iliohypogastric nerve blocks--before or after cesarean delivery under spinal anesthesia? Anesth. Analg. 1996; 82(1): 8-12.https://dx.doi.org/10.1097/00000539-199601000-00003.
Bell E.A., Jones B.P., Olufolabi A.J., Dexter F., Phillips-Bute B., Greengrass R.A. et al.; Duke Women's Anesthesia Research Group. Iliohypogastric-ilioinguinal peripheral nerve block for post-Cesarean delivery analgesia decreases morphine use but not opioid-related side effects. Can. J. Anaesth. 2002; 49(7): 694-700. https://dx.doi.org/10.1007/BF03017448.
Nair V., Henry R. Bilateral paravertebral block: a satisfactory alternative for labour analgesia. Can. J. Anaesth. 2001; 48(2): 179-84. https://dx.doi.org/10.1007/BF03019732.
Sultan P., Patel S.D., Jadin S., Carvalho B., Halpern S.H. Transversus abdominis plane block compared with wound infiltration for postoperative analgesia following Cesarean delivery: a systematic review and network meta-analysis. Can. J. Anaesth. 2020; 67(12): 1710-27. https://dx.doi.org/10.1007/s12630-020-01818-x.
Forero M., Adhikary S.D., Lopez H., Tsui C., Chin K.J. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg. Anesth. Pain Med. 2016; 41(5): 621-7. https://dx.doi.org/10.1097/AAP.0000000000000451.
Kot P., Rodriguez P., Granell M., Cano B., Rovira L., Morales J. et al. The erector spinae plane block: a narrative review. Korean J. Anesthesiol. 2019; 72(3): 209-20. https://dx.doi.org/10.4097/kja.d.19.00012.
Restrepo-Garces C.E., Chin K.J., Suarez P., Diaz A. Bilateral continuous erector spinae plane block contributes to effective postoperative analgesia after major open abdominal surgery: a case report. A A Case Rep. 2017; 9(11): 319-21. https://dx.doi.org/10.1213/XAA.0000000000000605.
Das Adhikary S., Pruett A., Forero M., Thiruvenkatarajan V. Erector spinae plane block as an alternative to epidural analgesia for post-operative analgesia following video-assisted thoracoscopic surgery: A case study and a literature review on the spread of local anaesthetic in the erector spinae plane. Indian J. Anaesth. 2018; 62(1): 75-8. https://dx.doi.org/10.4103/ija.IJA_693_17.
Bonvicini D., Tagliapietra L., Giacomazzi A., Pizzirani E. Bilateral ultrasound-guided erector spinae plane blocks in breast cancer and reconstruction surgery. J. Clin. Anesth. 2018; 44: 3-4. https://dx.doi.org/10.1016/j.jclinane.2017.10.006.
Wilson J.M., Lohser J., Klaibert B. Erector spinae plane block for postoperative rescue analgesia in thoracoscopic surgery. J. Cardiothorac. Vasc. Anesth. 2018; 32(6): e5-e7. https://dx.doi.org/10.1053/j.jvca.2018.06.026.
Luis-Navarro J.C., Seda-Guzmán M., Luis-Moreno C., López-Romero J.L. The erector spinae plane block in 4 cases of video-assisted thoracic surgery. Rev. Esp. Anestesiol. Reanim. (Engl Ed). 2018; 65(4): 204-8. https://dx.doi.org/10.1016/j.redar.2017.12.004.
De Cassai A., Ieppariello G., Ori C. Erector spinae plane block and dual antiplatelet therapy. Minerva Anestesiol. 2018; 84(10): 1230-1.https://dx.doi.org/10.23736/S0375-9393.18.12815-X.
Das Adhikary S., Prasad A., Soleimani B., Chin K.J. Continuous erector spinae plane block as an effective analgesic option in anticoagulated patients after left ventricular assist device implantation: a case series. J. Cardiothorac. Vasc. Anesth. 2019; 33(4): 1063-7. https://dx.doi.org/10.1053/j.jvca.2018.04.026.
Wyatt K., Elattary T. The erector spinae plane block in a high-risk Ehlers-Danlos syndrome pediatric patient for vascular ring repair. J. Clin. Anesth. 2019; 54: 39-40. https://dx.doi.org/10.1016/j.jclinane.2018.10.031.
Boules M.L., Goda A.S., Abdelhady M.A., El-Nour Abd El-Azeem S.A.A., Hamed M.A. Comparison of analgesic effect between erector spinae plane block and transversus abdominis plane block after elective cesarean section: a prospective randomized single-blind controlled study. J. Pain Res. 2020; 13: 1073-80. https://dx.doi.org/10.2147/JPR.S253343.
Belavy D., Cowlishaw P.J., Howes M., Phillips F. Ultrasound-guided transversus abdominis plane block for analgesia after Caesarean delivery. Br. J. Anaesth. 2009; 103(5): 726-30. https://dx.doi.org/10.1093/bja/aep235.
El-Boghdadly K., Desai N., Halpern S., Blake L., Odor P.M., Bampoe S. et al. Quadratus lumborum block vs. transversus abdominis plane block for caesarean delivery: a systematic review and network meta-analysis. Anaesthesia. 2021; 76(3): 393-403. https://dx.doi.org/10.1111/anae.15160.
Gitman M., Barrington M.J. Local anesthetic systemic toxicity: a review of recent case reports and registries. Reg. Anesth. Pain Med. 2018; 43(2): 124-30.https://dx.doi.org/10.1097/AAP.0000000000000721.
Akerman M., Pejčić N., Veličković I. A review of the quadratus lumborum block and ERAS. Front. Med. (Lausanne). 2018; 5: 44. https://dx.doi.org/10.3389/fmed.2018.00044.
Ueshima H., Otake H., Lin J.A. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. Biomed. Res. Int. 2017; 2017: 2752876. https://dx.doi.org/10.1155/2017/2752876.
Krohg A., Ullensvang K., Rosseland L.A., Langesæter E., Sauter A.R. The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: a randomized clinical trial. Anesth. Analg. 2018; 126(2): 559-65. https://dx.doi.org/10.1213/ANE.0000000000002648.
Liu X., Song T., Chen X., Zhang J., Shan C., Chan L., Xu H. Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol. 2020; 20(1): 53.https://dx.doi.org/10.1186/s12871-020-00967-2.
Salama E.R. Ultrasound-guided bilateral quadratus lumborum block vs. intrathecal morphine for postoperative analgesia after cesarean section: a randomized controlled trial. Korean J. Anesthesiol. 2020; 73(2): 121-8.https://dx.doi.org/10.4097/kja.d.18.00269.

Received 11.01.2023

Accepted 09.03.2023

Artem V. Kornienko, anesthesiologist-resuscitator, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia, +7(906)652-92-09, a_kornienko@oparina4.ru, https://orcid.org/0000-0001-9670-7219, 117997, Russia, Moscow, Ac. Oparin str., 4.
Anastasiya V. Nitchenko, graduate student, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia, +7(495)438-77-77, nosferas95@mail.ru, https://orcid.org/0000-0002-4904-7913, 117997, Russia, Moscow, Ac. Oparin str., 4.
Pavel V. Troshin, anesthesiologist-resuscitator, Assistant of the Department of Anesthesiology and Resuscitation, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(495)438-77-77, p_troshin@oparina4.ru, https://orcid.org/0000-0002-4904-7913,
117997, Russia, Moscow, Ac. Oparin str., 4.
Aleksey V. Pyregov, Dr. Med. Sci., Professor, Director of the Institute of Anesthesiology-Resuscitation and Transfusiology, Head of the Department of Anesthesiology-Intensive Care, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia,
+7(916)140-65-49, Pyregov@mail.ru, https://orcid.org/0000-0001-8382-9671, 117997, Russia, Moscow, Ac. Oparin str., 4.

Transversus abdominis plane nerve blocks in the concept of enhanced recovery after a cesarean section

Kornienko A.V., Nitchenko A.V., Troshin P.V., Pyregov A.V.

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