Education  |   November 2019
Transversus Abdominis Plane Block: A Narrative Review
Author Notes
  • From the Department of Anesthesiology, McGill University, Montreal, Quebec, Canada (D.Q.T.); Department of Anesthesiology and Perioperative Medicine, Clinical Hospital of the University of Chile, University of Chile, Santiago, Chile (D.B.); Department of Anesthesiology, Faculty of Medicine, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand (P.L.); Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington (J.M.N.).
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Submitted for publication February 9, 2019. Accepted for publication May 13, 2019.
    Submitted for publication February 9, 2019. Accepted for publication May 13, 2019.×
  • Address correspondence to Dr. Tran: St. Mary’s Hospital, Department of Anesthesiology, 3830 Ave Lacombe, Montreal, Quebec, Canada H3T-1M5. de_tran@hotmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Review Article / Pain Medicine / Pharmacology / Regional Anesthesia
Education   |   November 2019
Transversus Abdominis Plane Block: A Narrative Review
Anesthesiology 11 2019, Vol.131, 1166-1190. doi:https://doi.org/10.1097/ALN.0000000000002842
Anesthesiology 11 2019, Vol.131, 1166-1190. doi:https://doi.org/10.1097/ALN.0000000000002842
Abstract

In this narrative review article, the authors discuss the anatomy, nomenclature, history, approaches (posterior vs. lateral vs. subcostal), techniques, pharmacology, indications, and complications of transversus abdominis plane blocks, as well as possible alternative truncal blocks.

Despite the scarcity of evidence and contradictory findings, certain clinical suggestions can nonetheless be made. Overall transversus abdominis plane blocks appear most beneficial in the setting of open appendectomy (posterior or lateral approach). Lateral transversus abdominis plane blocks are not suggested for laparoscopic hysterectomy, laparoscopic appendectomy, or open prostatectomy. However, transversus abdominis plane blocks could serve as an analgesic option for Cesarean delivery (posterior or lateral approach) and open colorectal section (subcostal or lateral approach) if there exist contraindications to intrathecal morphine and thoracic epidural analgesia, respectively.

Future investigation is required to compare posterior and subcostal transversus abdominis plane blocks in clinical settings. Furthermore, posterior transversus abdominis plane blocks should be investigated for surgical interventions in which their lateral counterparts have proven not to be beneficial (e.g., laparoscopic hysterectomy/appendectomy, open prostatectomy). More importantly, because posterior transversus abdominis plane blocks can purportedly provide sympathetic blockade and visceral analgesia, they should be compared with thoracic epidural analgesia for open colorectal surgery. Finally, transversus abdominis plane blocks should be compared with newer truncal blocks (e.g., erector spinae plane and quadratus lumborum blocks) with well-designed and adequately powered trials.