In this study, researchers analyzed some of the newer regional anesthetic techniques, long-acting local anesthetics, and adjuvants, and discuss evidence for key outcomes such as cancer recurrence and safety with ultrasound guidance. Advances in ultrasound-guided regional anesthesia and the introduction of newer long-acting local anesthetics have given clinicians an opportunity to apply novel approaches to block peripheral nerves with ease.
Consequently, improvements in outcomes such as quality of analgesia, early rehabilitation, and patient satisfaction have been observed. In the last decade, the practice of regional anesthesia has advanced significantly, particularly following the introduction of ultrasound-guided regional anesthesia (UGRA).
Also, benefits of regional anesthesia on cancer recurrence and prevention of chronic post-surgical pain have gained focus in the recent years. In this article, they will evaluate some of the newer regional anesthetic techniques, long-acting local anesthetics, and adjuvants, and discuss evidence for key outcomes.
Transversus abdominis plane (TAP) infiltration has become an increasingly popular option for both ambulatory and inpatient abdominal procedures and provides analgesia to the parietal peritoneum and anterior abdominal wall. Local anesthetic deposited in the plane between the QL muscle and the medial layer of the thoracolumbar fascia.
It can provide relief of somatic pain in the upper and lower abdomen. Due to the more dorsal injection point and potential spread to the paravertebral space, QL blocks can cover more extensive dermatomes for a significantly longer duration of analgesia as compared to TAP blocks.
Erector spinae plane (ESP) block is an interfacial plane block that entails deposition of local anesthetic deep to erector spinae muscle adjacent to transverse processes. A single injection of 20 ml of 0.5% ropivacaine at T5 level can result in sensory blockade from T3 to T9 over posterior thorax and T3 to the T6 anterolateral thoracic area by blocking the ventral and dorsal rami of the thoracic spinal nerves.
Femoral nerve block (FNB) has become a common and highly effective method to control post-operative pain in this population. It also avoids risks associated with epidural anesthesia and does not prohibit deep vein thrombosis prophylaxis. In recent years, the adductor canal block (ACB) has become an attractive alternative to FNB due to its quadriceps-sparing activity to facilitate early rehabilitation programme.
The practice of regional anesthesia has advanced rapidly in recent years with the application of ultrasonography resulting in significant improvement in the quality of nerve blocks and patient satisfaction. Although adjuvants such as dexamethasone have shown prolongation of the duration of block their widespread use in routine practice has not been observed.
While regional anesthesia is effective for the adequate management of acute pain, its beneficial effect on the development of chronic pain and cancer recurrence needs further research.