Transversus abdominis plane nerve blocks in the concept of enhanced recovery after a cesarean section

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Abstract

One of the main elements of the strategy of fast track surgery or enhanced recovery after surgery (ERAS) is to activate a patient in the early postoperative period after any surgery; however, this is not achievable without pain control in the early postoperative period. In this case, cesarean section is no exception. Non-optimal analgesia is associated with delayed functional recovery, delayed mobilization, which may increase the risk of thromboembolic events, delay early mother-infant contact, and increase the risk of postpartum depression. The modern approach to adequate analgesia includes the principle of multimodality, which has an impact on all components of a nociceptive impulse. Epidural anesthesia, as well as abdominis neurofascial plane nerve block (quadratus lumborum (QL) or transversus abdominis plane (TAP) block, erector spinae plane (ESP) block), which is a variety of peripheral or regional block of the nerves involved in the innervation of the anterior abdominal wall, play a unique role in multimodal pain management regimens after a cesarean section, and also allow the amount of opioids to be reduced, which is an important element of the Fast Track concept.

Conclusion: QL block and ESP block can become promising methods for regional anesthesia after TAP block. Further randomized controlled safety trials are needed to identify the risk of the toxicity and efficacy of abdominal wall blocks and their impact on the visceral component of pain after a caesarean section.

About the authors

Artem V. Kornienko

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Author for correspondence.
Email: a_kornienko@oparina4.ru
ORCID iD: 0000-0001-9670-7219

Anesthesiologist-Resuscitator

Russian Federation, Moscow

Anastasiya V. Nitchenko

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: nosferas95@mail.ru

Graduate Student

Russian Federation, Moscow

Pavel V. Troshin

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: p_troshin@oparina4.ru
ORCID iD: 0000-0002-4904-7913

Anesthesiologist-Resuscitator, Assistant of the Department of Anesthesiology and Resuscitation

Russian Federation, Moscow

Aleksey V. Pyregov

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: Pyregov@mail.ru
ORCID iD: 0000-0001-8382-9671

Dr. Med. Sci., Professor, Director of the Institute of Anesthesiology-Resuscitation and Transfusiology, Head of the Department of Anesthesiology-Intensive Care

Russian Federation, Moscow

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