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Alt ve üst abdominal cerrahilerde multimodal anestezi uygulamaları kapsamında yapılan ultrason eşliğinde periferik sinir bloklarına genel bakış

Year 2025, Volume: 18 Issue: 4, 941 - 949, 01.10.2025
https://doi.org/10.31362/patd.1655768

Abstract

Kronik ağrıyı önlemek, fonksiyonu korumak ve yaşam kalitesini artırmak için etkili akut postoperatif ağrı yönetimi çok önemlidir. Postoperatif ağrının etkili bir şekilde kontrol edilmesi için multimodal anestezi protokolleri yaygın olarak önerilmektedir. Opioidlerin yan etkileri nedeniyle, opioid içermeyen analjezik yaklaşımlara yönelme eğilimi artmıştır. Periferik sinir blokları bu yaklaşımı desteklemektedir. Üst abdominal cerrahide kullanılan sinir blokları arasında eksternal oblik interkostal bloğu ve paravertebral blok; alt abdominal cerrahide kullanılan sinir blokları arasında transversalis fasya plan bloğu yer alır. Üst ve alt karın cerrahisinde kullanılan sinir blokları transversus abdominis plan bloğu ve bilateral erektör spina plan bloğu örnek verilebilir. Bu blokların uygun kullanımı, opioid kullanımını azaltır, kronik ağrıyı önler ve hasta memnuniyetini artırır.

References

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  • WHO guidelines on the pharmacological treatment of persisting pain in children with medical ıllnesses. Available at: https://www.ncbi.nlm.nih.gov/books/NBK138354/. Accessed 2012
  • Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010;9(8):807-19. doi:10.1016/S1474-4422(10)70143-5
  • Brown EN, Pavone KJ, Naranjo M. Multimodal general anesthesia: theory and practice. Anesth Analg. 2018;127(5):1246-1258. doi:10.1213/ANE.0000000000003668
  • Cho AM, Xiong JS, Burns SL. The emerging role of peripheral nerve stimulation in postoperative analgesia. Curr Pain Headache Rep. 2023;27(10):601-605. doi:10.1007/s11916-023-01159-6
  • Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618-1625. doi:10.1016/S0140-6736(06)68700-X
  • Kehlet H. Postoperative pain, analgesia, and recovery-bedfellows that cannot be ignored. Pain. 2018;159(1):11-16. doi:10.1097/j.pain.0000000000001243
  • Lindberg Larsen V, Ostrowski SR, Lindberg Larsen M, Rovsing ML, Johansson PI, Kehlet H. The effect of pre-operative methylprednisolone on early endothelial damage after total knee arthroplasty: a randomised, double-blind, placebo-controlled trial. Anaesthesia. 2017;72:1217-1224. doi:10.1111/anae.13983
  • Lunn TH, Kristensen BB, Andersen LO, et al. Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial. Br J Anaesth. 2011;106:230-238. doi:10.1093/bja/aeq333
  • Motte L, Kehlet H, Vogt K, et al. Preoperative methylprednisolone enhances recovery after endovascular aortic repair: a randomized, double-blind, placebo-controlled clinical trial. Ann Surg. 2014;260:540-549. doi:10.1097/SLA.0000000000000895
  • Gorsky K, Black ND, Niazi A, et al. Psychological interventions to reduce postoperative pain and opioid consumption: a narrative review of literature. Reg Anesth Pain Med. 2021;46(10):893-903. doi:10.1136/rapm-2020-102434
  • Kehlet H, Dahl JB. The value of "multimodal" or "balanced analgesia" in postoperative pain treatment. Anesth Analg. 1993;77(5):1048-1056. doi:10.1213/00000539-199311000-00030
  • Ladha KS, Patorno E, Huybrechts KF, Liu J, Rathmell JP, Bateman BT. Variations in the use of perioperative multimodal analgesic therapy. Anesthesiology. 2016;124(4):837-845. doi:10.1097/ALN.0000000000001034
  • American society of anesthesiologists task force on acute pain management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the american society of anesthesiologists task force on acute pain management. Anesthesiology. 2012;116(2):248-273. doi:10.1097/ALN.0b013e31823c1030
  • Joshi GP, Kehlet H; prospect working group. guidelines for perioperative pain management: need for re-evaluation. Br J Anaesth. 2017;119(4):703-706. doi:10.1093/bja/aex304
  • Shanthanna H, Ladha KS, Kehlet H, Joshi GP. Perioperative opioid administration. Anesthesiology. 2021;134(4):645-659. doi:10.1097/ALN.0000000000003572
  • Yan H, Chen W, Chen Y, et al. Opioid-free versus opioid-based anesthesia on postoperative pain after thoracoscopic surgery: the use of ıntravenous and epidural esketamine. Anesth Analg. 2023;137(2):399-408. doi:10.1213/ANE.0000000000006547
  • Liu Z, Bi C, Li X, Song R. The efficacy and safety of opioid-free anesthesia combined with ultrasound-guided intermediate cervical plexus block vs. opioid-based anesthesia in thyroid surgery-a randomized controlled trial. J Anesth. 2023;37(6):914-922. doi:10.1007/s00540-023-03254-9
  • Beloeil H. Opioid-free anesthesia. Best Pract Res Clin Anaesthesiol. 2019;33(3):353-360. doi:10.1016/j.bpa.2019.09.002
  • Butterworth JF, Mackey DC, Wasnick JD. Morgan and Mikhail`s Clinical Anesthesiology. New York: McGraw Hill Medical; 2022:1290.
  • Elsharkawy H, Kolli S, Soliman LM, et al. the external oblique ıntercostal block: anatomic evaluation and case series. Pain Med. 2021;22(11):2436-2442. doi:10.1093/pm/pnab296
  • Alrashed D, Harte S, Mislovic B. Opioid-free anesthesia for a child with patau syndrome with external oblique ıntercostal fascial plane blocks. Paediatr Anaesth. 2025;35(3):249-250. doi:10.1111/pan.15052
  • Erskine RN, White L. A review of the external oblique intercostal plane block - a novel approach to analgesia for upper abdominal surgery. J Clin Anesth. 2022;82:110953. doi:10.1016/j.jclinane.2022.110953
  • Doymus O, Ahiskalioglu A, Kaciroglu A, et al. External oblique ıntercostal plane block versus port-site ınfiltration for laparoscopic sleeve gastrectomy: a randomized controlled study. Obes Surg. 2024;34(5):1826-1833. doi:10.1007/s11695-024-07219-z
  • Tang J, Hua Q, Zhang Y, Nie W, Yu S, Zhang J. Effects of ultrasound-guided external oblique intercostal plane block on the postoperative analgesia after open liver surgery: study protocol for a randomised controlled trial. Trials. 2024;16;25(1):776. doi.org/10.1186/s13063-024-08449-3
  • Yi S, Li D, Zhang XL, Duan FY, Gao H, Kong MJ. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study. Open Med (Wars). 2024;19(1):20241068. doi:10.1515/med-2024-1068
  • Geng C, Wang L, Shi Y, et al. Bilateral erector spinae plane block on opioid-sparing effect in upper abdominal surgery: study protocol for a bi-center prospective randomized controlled trial. Trials. 2024;25(1):761. doi:10.1186/s13063-024-08612-w
  • Priya V, Shamim R, Singh B, Singh S, Bais PS, Prasad G. Comparative evaluation of pre-emptive analgesic efficacy of posterior transversus abdominis plane block with fascia transversalis plane block in adult patients undergoing unilateral inguinal hernia repair: a prospective, randomized, single-blind, two-arm parallel study. Saudi J Anaesth. 2024;18(2):211-217. doi:10.4103/sja.sja_893_23
  • Pinarbaşi A, Altiparmak B, Korkmaz Toker M, Pirinççi F, Uğur B. Ultrasound-guided transversalis fascia plane block or transversus abdominis plane block for recovery after caesarean section: A randomised clinical trial. Eur J Anaesthesiol. 2024;41(10):769-778. doi:10.1097/EJA.0000000000002041
  • Hebbard PD. Transversalis fascia plane block, a novel ultrasound-guided abdominal wall nerve block. Can J Anaesth. 2009;56(8):618-620. doi:10.1007/s12630-009-9110-1
  • Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024-1026. doi:10.1046/j.1365-2044.2001.02279-40.x
  • Baumgartner WC, Richards FM, Arnsberger BJ, Sheets D, Powell J Jr. Comparing ultrasound- and laparoscopic-guided transversus abdominis plane (tap) blocks in sleeve gastrectomy patients. Cureus. 2024;16(12):e76033. doi:10.7759/cureus.76033
  • Tsai HC, Yoshida T, Chuang TY, et al. Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int. 2017;8284363. doi:10.1155/2017/8284363
  • Agarwal J, Babuwe-Ngobi J, Belani KG, Malhotra N. Peripheral nerve blocks for analgesia following cesarean delivery A narrative review. J Anaesthesiol Clin Pharmacol. 2024;40(2):192-198. doi:10.4103/joacp.joacp_204_22
  • Yang TR, He XM, Li XH, Wang RR. Intrathecal morphine versus transversus abdominis plane block for caesarean delivery: a systematic review and meta-analysis. BMC Anesthesiol. 2021;21(1):174. doi.org/10.1186/s12871-021-01392-9
  • 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
  • Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621-627. doi:10.1097/AAP.0000000000000451
  • Park YJ, Chu S, Yu E, Joo JD. Comparison of the efficacy of erector spinae plane block according to the difference in bupivacaine concentrations for analgesia after laparoscopic cholecystectomy: a retrospective study. J Yeungnam Med Sci. 2023;40(2):172-178. doi:10.12701/jyms.2022.00500
  • Shim JW, Jung S, Moon HW, et al. Rectus sheath block for acute pain management after robot-assisted prostatectomy. Asian J Surg. 2022;45(10):1843-1848. doi:10.1016/j.asjsur.2021.10.035
  • Yörükoğlu HU, Şahin T, Öge Kula A. Transversus abdominis plane block versus rectus sheath block for postoperative pain after caesarean delivery: a randomised controlled trial. Turk J Anaesthesiol Reanim. 2023;51(1):43-48. doi:10.5152/TJAR.2023.22724
  • Abdildin Y, Tapinova K, Salamat A, Shaimakhanov R, Aitbayev A, Viderman D. Rectus sheath block in abdominal surgery: a systematic review with meta-analysis. Rom J Anaesth Intensive Care. 2023;30(1):43-50. doi:10.2478/rjaic-2023-0006

Overview of ultrasound-guided plane blocks performed within the scope of multimodal anesthesia applications in lower and upper abdominal surgeries

Year 2025, Volume: 18 Issue: 4, 941 - 949, 01.10.2025
https://doi.org/10.31362/patd.1655768

Abstract

Effective acute postoperative pain management is essential to prevent chronic pain, preserve function, and enhance quality of life. Multimodal anesthesia protocols are widely recommended for effective control of postoperative pain. Due to the side effects of opioids, there has been an increase in the tendency towards non-opioid based analgesic approaches. Peripheral nerve blocks support this approach. Nerve blocks used in upper abdominal surgery include external oblique intercostal block and paravertebral block; nerve blocks used in lower abdominal surgery include transversalis fascia plane block. Nerve blocks used in upper and lower abdominal surgery include transversus abdominis plane block and bilateral erector spina plane block. Appropriate use of these blocks reduces opioid use, prevents chronic pain, and improves patient satisfaction.

References

  • Orr PM, Shank BC, Black AC. The role of pain classification systems in pain management. Crit Care Nurs Clin North Am. 2017;29(4):407-418. doi:10.1016/j.cnc.2017.08.002
  • WHO guidelines on the pharmacological treatment of persisting pain in children with medical ıllnesses. Available at: https://www.ncbi.nlm.nih.gov/books/NBK138354/. Accessed 2012
  • Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010;9(8):807-19. doi:10.1016/S1474-4422(10)70143-5
  • Brown EN, Pavone KJ, Naranjo M. Multimodal general anesthesia: theory and practice. Anesth Analg. 2018;127(5):1246-1258. doi:10.1213/ANE.0000000000003668
  • Cho AM, Xiong JS, Burns SL. The emerging role of peripheral nerve stimulation in postoperative analgesia. Curr Pain Headache Rep. 2023;27(10):601-605. doi:10.1007/s11916-023-01159-6
  • Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618-1625. doi:10.1016/S0140-6736(06)68700-X
  • Kehlet H. Postoperative pain, analgesia, and recovery-bedfellows that cannot be ignored. Pain. 2018;159(1):11-16. doi:10.1097/j.pain.0000000000001243
  • Lindberg Larsen V, Ostrowski SR, Lindberg Larsen M, Rovsing ML, Johansson PI, Kehlet H. The effect of pre-operative methylprednisolone on early endothelial damage after total knee arthroplasty: a randomised, double-blind, placebo-controlled trial. Anaesthesia. 2017;72:1217-1224. doi:10.1111/anae.13983
  • Lunn TH, Kristensen BB, Andersen LO, et al. Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial. Br J Anaesth. 2011;106:230-238. doi:10.1093/bja/aeq333
  • Motte L, Kehlet H, Vogt K, et al. Preoperative methylprednisolone enhances recovery after endovascular aortic repair: a randomized, double-blind, placebo-controlled clinical trial. Ann Surg. 2014;260:540-549. doi:10.1097/SLA.0000000000000895
  • Gorsky K, Black ND, Niazi A, et al. Psychological interventions to reduce postoperative pain and opioid consumption: a narrative review of literature. Reg Anesth Pain Med. 2021;46(10):893-903. doi:10.1136/rapm-2020-102434
  • Kehlet H, Dahl JB. The value of "multimodal" or "balanced analgesia" in postoperative pain treatment. Anesth Analg. 1993;77(5):1048-1056. doi:10.1213/00000539-199311000-00030
  • Ladha KS, Patorno E, Huybrechts KF, Liu J, Rathmell JP, Bateman BT. Variations in the use of perioperative multimodal analgesic therapy. Anesthesiology. 2016;124(4):837-845. doi:10.1097/ALN.0000000000001034
  • American society of anesthesiologists task force on acute pain management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the american society of anesthesiologists task force on acute pain management. Anesthesiology. 2012;116(2):248-273. doi:10.1097/ALN.0b013e31823c1030
  • Joshi GP, Kehlet H; prospect working group. guidelines for perioperative pain management: need for re-evaluation. Br J Anaesth. 2017;119(4):703-706. doi:10.1093/bja/aex304
  • Shanthanna H, Ladha KS, Kehlet H, Joshi GP. Perioperative opioid administration. Anesthesiology. 2021;134(4):645-659. doi:10.1097/ALN.0000000000003572
  • Yan H, Chen W, Chen Y, et al. Opioid-free versus opioid-based anesthesia on postoperative pain after thoracoscopic surgery: the use of ıntravenous and epidural esketamine. Anesth Analg. 2023;137(2):399-408. doi:10.1213/ANE.0000000000006547
  • Liu Z, Bi C, Li X, Song R. The efficacy and safety of opioid-free anesthesia combined with ultrasound-guided intermediate cervical plexus block vs. opioid-based anesthesia in thyroid surgery-a randomized controlled trial. J Anesth. 2023;37(6):914-922. doi:10.1007/s00540-023-03254-9
  • Beloeil H. Opioid-free anesthesia. Best Pract Res Clin Anaesthesiol. 2019;33(3):353-360. doi:10.1016/j.bpa.2019.09.002
  • Butterworth JF, Mackey DC, Wasnick JD. Morgan and Mikhail`s Clinical Anesthesiology. New York: McGraw Hill Medical; 2022:1290.
  • Elsharkawy H, Kolli S, Soliman LM, et al. the external oblique ıntercostal block: anatomic evaluation and case series. Pain Med. 2021;22(11):2436-2442. doi:10.1093/pm/pnab296
  • Alrashed D, Harte S, Mislovic B. Opioid-free anesthesia for a child with patau syndrome with external oblique ıntercostal fascial plane blocks. Paediatr Anaesth. 2025;35(3):249-250. doi:10.1111/pan.15052
  • Erskine RN, White L. A review of the external oblique intercostal plane block - a novel approach to analgesia for upper abdominal surgery. J Clin Anesth. 2022;82:110953. doi:10.1016/j.jclinane.2022.110953
  • Doymus O, Ahiskalioglu A, Kaciroglu A, et al. External oblique ıntercostal plane block versus port-site ınfiltration for laparoscopic sleeve gastrectomy: a randomized controlled study. Obes Surg. 2024;34(5):1826-1833. doi:10.1007/s11695-024-07219-z
  • Tang J, Hua Q, Zhang Y, Nie W, Yu S, Zhang J. Effects of ultrasound-guided external oblique intercostal plane block on the postoperative analgesia after open liver surgery: study protocol for a randomised controlled trial. Trials. 2024;16;25(1):776. doi.org/10.1186/s13063-024-08449-3
  • Yi S, Li D, Zhang XL, Duan FY, Gao H, Kong MJ. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study. Open Med (Wars). 2024;19(1):20241068. doi:10.1515/med-2024-1068
  • Geng C, Wang L, Shi Y, et al. Bilateral erector spinae plane block on opioid-sparing effect in upper abdominal surgery: study protocol for a bi-center prospective randomized controlled trial. Trials. 2024;25(1):761. doi:10.1186/s13063-024-08612-w
  • Priya V, Shamim R, Singh B, Singh S, Bais PS, Prasad G. Comparative evaluation of pre-emptive analgesic efficacy of posterior transversus abdominis plane block with fascia transversalis plane block in adult patients undergoing unilateral inguinal hernia repair: a prospective, randomized, single-blind, two-arm parallel study. Saudi J Anaesth. 2024;18(2):211-217. doi:10.4103/sja.sja_893_23
  • Pinarbaşi A, Altiparmak B, Korkmaz Toker M, Pirinççi F, Uğur B. Ultrasound-guided transversalis fascia plane block or transversus abdominis plane block for recovery after caesarean section: A randomised clinical trial. Eur J Anaesthesiol. 2024;41(10):769-778. doi:10.1097/EJA.0000000000002041
  • Hebbard PD. Transversalis fascia plane block, a novel ultrasound-guided abdominal wall nerve block. Can J Anaesth. 2009;56(8):618-620. doi:10.1007/s12630-009-9110-1
  • Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024-1026. doi:10.1046/j.1365-2044.2001.02279-40.x
  • Baumgartner WC, Richards FM, Arnsberger BJ, Sheets D, Powell J Jr. Comparing ultrasound- and laparoscopic-guided transversus abdominis plane (tap) blocks in sleeve gastrectomy patients. Cureus. 2024;16(12):e76033. doi:10.7759/cureus.76033
  • Tsai HC, Yoshida T, Chuang TY, et al. Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int. 2017;8284363. doi:10.1155/2017/8284363
  • Agarwal J, Babuwe-Ngobi J, Belani KG, Malhotra N. Peripheral nerve blocks for analgesia following cesarean delivery A narrative review. J Anaesthesiol Clin Pharmacol. 2024;40(2):192-198. doi:10.4103/joacp.joacp_204_22
  • Yang TR, He XM, Li XH, Wang RR. Intrathecal morphine versus transversus abdominis plane block for caesarean delivery: a systematic review and meta-analysis. BMC Anesthesiol. 2021;21(1):174. doi.org/10.1186/s12871-021-01392-9
  • 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
  • Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621-627. doi:10.1097/AAP.0000000000000451
  • Park YJ, Chu S, Yu E, Joo JD. Comparison of the efficacy of erector spinae plane block according to the difference in bupivacaine concentrations for analgesia after laparoscopic cholecystectomy: a retrospective study. J Yeungnam Med Sci. 2023;40(2):172-178. doi:10.12701/jyms.2022.00500
  • Shim JW, Jung S, Moon HW, et al. Rectus sheath block for acute pain management after robot-assisted prostatectomy. Asian J Surg. 2022;45(10):1843-1848. doi:10.1016/j.asjsur.2021.10.035
  • Yörükoğlu HU, Şahin T, Öge Kula A. Transversus abdominis plane block versus rectus sheath block for postoperative pain after caesarean delivery: a randomised controlled trial. Turk J Anaesthesiol Reanim. 2023;51(1):43-48. doi:10.5152/TJAR.2023.22724
  • Abdildin Y, Tapinova K, Salamat A, Shaimakhanov R, Aitbayev A, Viderman D. Rectus sheath block in abdominal surgery: a systematic review with meta-analysis. Rom J Anaesth Intensive Care. 2023;30(1):43-50. doi:10.2478/rjaic-2023-0006
There are 41 citations in total.

Details

Primary Language English
Subjects Anaesthesiology
Journal Section Review
Authors

Mert Yetgin 0009-0006-7838-558X

Hülya Sungurtekin 0000-0002-9453-5625

Hale Yetgin 0009-0005-9153-8221

Submission Date March 13, 2025
Acceptance Date June 30, 2025
Early Pub Date July 3, 2025
Publication Date October 1, 2025
Published in Issue Year 2025 Volume: 18 Issue: 4

Cite

AMA Yetgin M, Sungurtekin H, Yetgin H. Overview of ultrasound-guided plane blocks performed within the scope of multimodal anesthesia applications in lower and upper abdominal surgeries. Pam Med J. October 2025;18(4):941-949. doi:10.31362/patd.1655768

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