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Essentials of Our Current Understanding: Abdominal Wall Blocks

Chin, Ki Jinn FRCPC; McDonnell, John G. MD, FCARCSI; Carvalho, Brendan MD; Sharkey, Aidan FCAI; Pawa, Amit FRCA; Gadsden, Jeffrey MD, FRCPC, FANZCA

Regional Anesthesia and Pain Medicine: March/April 2017 - Volume 42 - Issue 2 - p 133–183
doi: 10.1097/AAP.0000000000000545

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.

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.

Accepted for publication October 12, 2016.

Address correspondence to: Ki Jinn Chin, FRCPC, Department of Anesthesia, Toronto Western Hospital, University of Toronto, McL 2-405, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8 (e-mail:

The authors declare no conflict of interest.

Copyright © 2017 by American Society of Regional Anesthesia and Pain Medicine.