Regional Anesthesia Techniques for Pain Management for Laparoscopic Surgery: a Review of the Current Literature

Alvaro Andrés Macías, John J Finneran, Alvaro Andrés Macías, John J Finneran

Abstract

Purpose of review: The field of regional anesthesia has evolved tremendously in the last 15 years. New anesthesia protocols for ambulatory surgery and enhanced recovery after surgery have been developed as well. The focus of these techniques and protocols has centered on patient satisfaction and pain control while minimizing the use of opioids. The field of ambulatory surgery and anesthesia continues to evolve, and regional anesthesia and its plane techniques are at the center of these changes.

Recent findings: Recent research has shown that regional techniques contribute to better pain control and patient experience and may decrease patient readmission rates. The safety of these techniques has been validated when performed by experienced practitioners. New techniques such as the erector spinae block (ESP) have been studied in the setting of laparoscopic surgery with promising results. Regional anesthesia techniques for patients presenting for laparoscopic surgery are safe and seem to provide benefits. Those are related to patient experience, pain control, and readmission rates. Different techniques can be applied to a specific type of intervention. Application of these techniques depend on the clinical picture and patient. Future research may help us clarify how these techniques may improve patient satisfaction and operating room efficiency. New regional blocks may also develop based on what we know today.

Keywords: Ambulatory; Anesthesia; Laparoscopic surgery; Regional pain.

Conflict of interest statement

Alvaro Andres Macias: I report no conflict of interests and have no disclosures.

© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

References

    1. • Rosero EB, Joshi GP. Hospital readmission after ambulatory laparoscopic cholecystectomy: incidence and predictors. J Surg Res [Internet]. 2017;219:108–15. Available from: 10.1016/j.jss.2017.05.071. This paper addresses hospital readmission after ambulatory laparoscopic cholecystectomy by using big data.
    1. Fu H, Fu Y, Xu X, Gao Y. Ultrasound-guided rectus sheath block combined with butorphanol for single-incision laparoscopic cholecystectomy: what is the optimal dose of ropivacaine? J Pain Res. 2020;13:2609–2615. doi: 10.2147/JPR.S265418.
    1. Pirrera B, Alagna V, Lucchi A, Berti P, Gabbianelli C, Martorelli G, et al. Transversus abdominis plane (TAP) block versus thoracic epidural analgesia (TEA) in laparoscopic colon surgery in the ERAS program. Surg Endosc. 2018;32(1):376–382. doi: 10.1007/s00464-017-5686-7.
    1. Maloney C, Kallis M, El-Shafy IA, Lipskar AM, Hagen J, Kars M. Ultrasound-guided bilateral rectus sheath block vs. conventional local analgesia in single port laparoscopic appendectomy for children with nonperforated appendicitis. J Pediatr Surg [Internet]. 2018;53(3):431–6. Available from: 10.1016/j.jpedsurg.2017.05.027.
    1. Steiner CA, Zeynal K, Moore BJ, Imshaug MC, Pickens G. Surgeries in hospital-based ambulatory surgery and hospital inpatient settings [Internet]. H-CUP. 2020 [cited 2021 Oct 8]. Available from: .
    1. Gignoux B, Blanchet MC, Lanz T, Vulliez A, Saffarini M, Bothorel H, et al. Should ambulatory appendectomy become the standard treatment for acute appendicitis? World J Emerg Surg. 2018;13(1):1–8. doi: 10.1186/s13017-018-0191-4.
    1. Chamberlain RS, Sakpal SV. A Comprehensive review of single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy. J Gastrointest Surg. 2009;13(9):1733–1740. doi: 10.1007/s11605-009-0902-y.
    1. Hain E, Maggiori L, Prost à la Denise J, Panis Y. Transversus abdominis plane (TAP) block in laparoscopic colorectal surgery improves postoperative pain management: a meta-analysis. Color Dis. 2018;20(4):279–87.
    1. Nyerges A. Pain mechanisms in laparoscopic surgery. Semin Laparosc Surg. 1994;1(4):215–218.
    1. Naja ZM, El-Rajab M, Ziade F, Al-Tannir M, Itani T. Preoperative vs. postoperative bilateral paravertebral blocks for laparoscopic cholecystectomy: a prospective randomized clinical trial. Pain Pract. 2011;11(6):509–15.
    1. Ekstein P, Szold A, Sagie B, Werbin N, Klausner JM, Weinbroum AA. Laparoscopic surgery may be associated with severe pain and high analgesia requirements in the immediate postoperative period. Ann Surg. 2006;243(1):41–46. doi: 10.1097/01.sla.0000193806.81428.6f.
    1. Mouton WG, Bessell JR, Otten KT, Maddern GJ. Pain after laparoscopy. Surg Endosc. 1999;13(5):445–448. doi: 10.1007/s004649901011.
    1. Hebbard PD, Barrington MJ, Vasey C. Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade: description of anatomy and clinical technique. Reg Anesth Pain Med. 2010;35(5):436–441. doi: 10.1097/AAP.0b013e3181e66702.
    1. • El-Boghdadly K, Wolmarans M, Stengel AD, Albrecht E, Chin KJ, Elsharkawy H, 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):571–80. This paper addresses the need for standardization of the current abdominal wall, paraspinal and chest wall regional techniques. This allows better research and clinical application of the techniques.
    1. Elsharkawy H, El-Boghdadly K, Barrington M. Quadratus lumborum block. Anesthesiology. 2019;130(2):322–335. doi: 10.1097/ALN.0000000000002524.
    1. Drake, Richard. Vogl, W. Mitchell A. Gray’s anatomy for students. In: Gray’s anatomy for students. 4th ed.
    1. Vleeming A, Schuenke MD, Danneels L, Willard FH. The functional coupling of the deep abdominal and paraspinal muscles: the effects of simulated paraspinal muscle contraction on force transfer to the middle and posterior layer of the thoracolumbar fascia. J Anat. 2014;225(4):447–462. doi: 10.1111/joa.12227.
    1. • Altıparmak B, Korkmaz Toker M, Uysal AI, Kuşçu Y, Gümüş Demirbilek S. Ultrasound-guided erector spinae plane block versus oblique subcostal transversus abdominis plane block for postoperative analgesia of adult patients undergoing laparoscopic cholecystectomy: randomized, controlled trial. J Clin Anesth [Internet]. 2019;57(December 2018):31–6. Available from: 10.1016/j.jclinane.2019.03.012. This paper is one of the first ones to address the effectiveness of erector spinae plane block for ambulatory laparoscopic surgery.
    1. Lim Y, Ocampo CE, Sia AT. A comparison of duration of analgesia of intrathecal 2.5 mg of bupivacaine, ropivacaine, and levobupivacaine in combined spinal epidural analgesia for patients in labor. Anesth Analg. 2004;98(1):235–9.
    1. Rasmussen SB, Saied NN, Bowens C, Mercaldo ND, Schildcrout JS, Malchow RJ. Duration of upper and lower extremity peripheral nerve blockade is prolonged with dexamethasone when added to ropivacaine: a retrospective database analysis. Pain Med (United States) 2013;14(8):1239–1247. doi: 10.1111/pme.12150.
    1. Erol DD, Yilmaz S, Polat C, Arikan Y. Efficacy of thoracic epidural analgesia for laparoscopic cholecystectomy. Adv Ther. 2008;25(1):45–52. doi: 10.1007/s12325-008-0005-2.
    1. Zingg U, Miskovic D, Hamel CT, Erni L, Oertli D, Metzger U. Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection : BBBenefit with epidural analgesia. Surg Endosc. 2009;23(2):276–282. doi: 10.1007/s00464-008-9888-x.
    1. Taqi A, Hong X, Mistraletti G, Stein B, Charlebois P, Carli F. Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program. Surg Endosc Other Interv Tech. 2007;21(2):247–252. doi: 10.1007/s00464-006-0069-5.
    1. Kim MK, Baek CW, Kang H, Choi GJ, Park YH, Yang SY, et al. Comparison of emergence after deep extubation using desflurane or desflurane with remifentanil in patients undergoing general anesthesia: a randomized trial. J Clin Anesth. 2016.
    1. Yaksh T. The physiology and pharmacology of spinal opiates. Middle East J Anesthesiol. 1990;10(4):413–422.
    1. Karakaya D, Büyükgöz F, Barş S, Güldouş F, Tür A. Addition of fentanyl to bupivacaine prolongs anesthesia and analgesia in axillary brachial plexus block. Reg Anesth Pain Med. 2001;26(5):434–438. doi: 10.1097/00115550-200109000-00008.
    1. Candido KD, Winnie AP, Ghaleb AH, Fattouh MW, Franco CD. Buprenorphine added to the local anesthetic for axillary brachial plexus block prolongs postoperative analgesia. Reg Anesth Pain Med. 2002;27(2):162–167. doi: 10.1053/rapm.2002.30671.
    1. Fanelli G, Casati A, Magistris L, Berti M, Albertin M Scarioni A, Torri G. Fentanyl does not improve the nerve block characteristics of axillary brachial plexus anaesthesia performed with ropivacaine. Acta Anaesthesiol Scand. 2001;45(5):590–4.
    1. Kong SK, Onsiong SMK, Chiu WKY, Li MKW. Use of intrathecal morphine for postoperative pain relief after elective laparoscopic colorectal surgery. Anaesthesia. 2002;57(12):1168–1173. doi: 10.1046/j.1365-2044.2002.02873.x.
    1. Motamed C, Bouaziz H, Franco D, Benhamou D. Analgesic effect of low-dose intrathecal morphine and bupivacaine in laparoscopic cholecystectomy. Anaesthesia. 2000;55(2):118–124. doi: 10.1046/j.1365-2044.2000.055002118.x.
    1. Kang RA, Chin KJ, Gwak MS, Kim GS, Choi SJ, Kim JM, 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;44(12):1059–1065.
    1. Sultan P, Gutierrez MC, Carvalho B. Neuraxial morphine and respiratory depression: Finding the right balance. Drugs. 2011;71(14):1807–1819. doi: 10.2165/11596250-000000000-00000.
    1. Aydin G, Aydin O. The efficacy of ultrasound-guided paravertebral block in laparoscopic cholecystectomy. Med. 2018;54(5):2–9.
    1. Naja MZ, Ziade MF, Lönnqvist PA. General anaesthesia combined with bilateral paravertebral blockade (T5–6) vs. general anaesthesia for laparoscopic cholecystectomy: a prospective, randomized clinical trial. Vol. 21, European Journal of Anaesthesiology. 2004. p. 489–95.
    1. Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, Tayara K, Younes F, et al. Thoracic paravertebral block: influence of the number of injections. Reg Anesth Pain Med. 2006;31(3):196–201.
    1. Schneider LF, Albornoz CR, Huang J, Cordeiro PG. Incidence of pneumothorax during tissue expander-implant reconstruction and algorithm for intraoperative management. Ann Plast Surg. 2014;73(3):279–281. doi: 10.1097/SAP.0b013e31827e2936.
    1. Niesen AD, Jacob AK, Law LA, Sviggum HP, Johnson RL. Complication rate of ultrasound-guided paravertebral block for breast surgery. Reg Anesth Pain Med. 2020;45(10):813–817. doi: 10.1136/rapm-2020-101402.
    1. Krishna Prasad GV, Khanna S, Jaishree S. Review of adjuvants to local anesthetics in peripheral nerve blocks: current and future trends. Saudi J Anaesth. 2020;14(1):77–84. doi: 10.4103/sja.SJA_423_19.
    1. Choi S, Rodseth R, McCartney CJL. Effects of dexamethasone as a local anaesthetic adjuvant for brachial plexus block: a systematic review and meta-analysis of randomized trials. Br J Anaesth [Internet]. 2014;112(3):427–39. Available from: 10.1093/bja/aet417.
    1. 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):545–552. doi: 10.1007/s00464-017-5871-8.
    1. Ortiz J, Suliburk JW, Wu K, Bailard NS, Mason C, Minard CG, et al. Bilateral transversus abdominis plane block does not decrease postoperative pain after laparoscopic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites. Reg Anesth Pain Med. 2012;37(2):188–192. doi: 10.1097/AAP.0b013e318244851b.
    1. Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011;113(4):904–925. doi: 10.1213/ANE.0b013e3182285e01.
    1. Ilfeld BM. Continuous peripheral nerve blocks: an update of the published evidence and comparison with novel, alternative analgesic modalities. Anesth Analg. 2017;124(1):308–335. doi: 10.1213/ANE.0000000000001581.
    1. Finneran JJ, Alexander B, Bechis SK, Sur RL, Ilfeld BM. Continuous erector spinae plane blocks with automated boluses for analgesia following percutaneous nephrolithotomy. Korean J Anesthesiol. 2021;74(2):178–180. doi: 10.4097/kja.20398.
    1. Chen L, Wu Y, Cai Y, Ye Y, Li L, Xia Y, et al. Comparison of programmed intermittent bolus infusion and continuous infusion for postoperative patient-controlled analgesia with thoracic paravertebral block catheter: a randomized, double-blind, controlled trial. Reg Anesth Pain Med. 2019;44(2):240–245. doi: 10.1136/rapm-2018-000031.
    1. Wu L, Wu L, Sun H, Dong C, Yu J. Corrigendum: effect of ultrasound-guided peripheral nerve blocks of the abdominal wall on pain relief after laparoscopic cholecystectomy (J Pain Res. 2019;12:1433–1439). J Pain Res. 2020;13:2169.
    1. 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 [Internet]. 2021;261:10–7. Available from: 10.1016/j.jss.2020.12.003.
    1. Wu RC, Jensen CC, Douaiher J, Madoff RD, Kwaan MR. Transversus abdominis plane block in laparoscopic colorectal surgery: a systematic review. Dis Colon Rectum. 2019;62(10):1248–1255. doi: 10.1097/DCR.0000000000001464.
    1. Selcuk S, Api M, Polat M, Arinkan A, Aksoy B, Akca T, et al. Effectiveness of local anesthetic on postoperative pain in different levels of laparoscopic gynecological surgery. Arch Gynecol Obstet. 2016;293(6):1279–1285. doi: 10.1007/s00404-015-3984-7.
    1. Oksar M, Koyuncu O, Turhanoglu S, Temiz M, Oran MC. Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy. J Clin Anesth [Internet]. 2016;34:72–8. Available from: 10.1016/j.jclinane.2016.03.033.
    1. Basaran B, Basaran A, Kozanhan B, Kasdogan E, Eryilmaz MA, Ozmen S. Analgesia and respiratory function after laparoscopic cholecystectomy in patients receiving ultrasound-guided bilateral oblique subcostal transversus abdominis plane block: a randomized double-blind study. Med Sci Monit. 2015;21:1304–1312. doi: 10.12659/MSM.893593.
    1. Ramkiran S, Jacob M, Honwad M, Vivekanand D, Krishnakumar M, Patrikar S. Ultrasound-guided combined fascial plane blocks as an intervention for pain management after laparoscopic cholecystectomy: a randomized control study. Anesth Essays Res. 2018;12(1):16. doi: 10.4103/aer.AER_157_17.
    1. Abdallah FW, Laffey JG, Halpern SH, Brull R. Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: a meta-analysis. Br J Anaesth [Internet]. 2013;111(5):721–35. Available from: 10.1093/bja/aet214.
    1. Deng W, Long X, Li M, Li C, Guo L, Xu G, et al. Quadratus lumborum block versus transversus abdominis plane block for postoperative pain management after laparoscopic colorectal surgery: a randomized controlled trial. Med (United States) 2019;98(52):1–5.
    1. Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery a report of 3 cases. Reg Anesth Pain Med. 2017;42(3):372–376. doi: 10.1097/AAP.0000000000000581.
    1. Yassen K, Lotfy M, Miligi A, Sallam A, Hegazi EARAM. Patient-controlled analgesia with and without transverse abdominis plane and rectus sheath space block in cirrhotic patients undergoing liver resection. J Anaesthesiol Clin Pharmacol. 2019;35(1):58–64. doi: 10.4103/joacp.JOACP_36_17.
    1. Shahait M, Lee DI. Application of TAP block in laparoscopic urological surgery: current status and future directions. Curr Urol Rep. 2019;20(5):13–16. doi: 10.1007/s11934-019-0883-7.
    1. Ueshima H. Pneumothorax after the erector spinae plane block. J Clin Anesth [Internet]. 2018;48(April):12. Available from: 10.1016/j.jclinane.2018.04.009.
    1. Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicin Evidence-Based Guidelines (Fourth Edition). Vol. 43, Regional Anesthesia and Pain Medicine. 2018;263–309.

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