Practical Review of Abdominal and Breast Regional Analgesia for Plastic Surgeons: Evidence and Techniques

Abstract

Regional analgesia has been increasing in popularity due to its opioid- sparing analgesic effects and utility in multimodal analgesia strategies. Several regional techniques have been used in plastic surgery; however, there is a lack of consensus on the indications and the comparative efficacy of these blocks. The goal of this review is to provide evidence-based recommendations on the most relevant types of interfascial plane blocks for abdominal and breast surgery. A systematic search of the PUBMED, EMBASE, and Cochrane databases was performed to identify the evidence associated with the different interfascial plane blocks used in plastic surgery. The search included all studies from inception to March 2020. A total of 126 studies were included and used in the synthesis of the information presented in this review. There is strong evidence for using the transversus abdominis plane blocks in both abdominoplasties as well as abdominally-based microvascular breast reconstruction as evidenced by a significant reduction in post-operative pain and opioid consumption. Pectoralis (I and II), serratus anterior, and erector spinae plane blocks all provide good pain control in breast surgeries. Finally, the serratus anterior plane block can be used as primary block or an adjunct to the pectoralis blocks for a wider analgesia coverage of the breast. All the reviewed blocks are safe and easy to administer. Interfascial plane blocks are effective and safe modalities used to reduce pain and opioid consumption after abdominal and breast plastic surgery.

Fig. 1.

Ultrasound view of the transversus abdominal plane block. EO: external oblique, IO: internal oblique, TA: transversus abdominis, PC: peritoneal cavity.

Fig. 2.

Ultrasound view of pectoral nerve blocks with respect to the fourth rib. SM: serratus anterior muscle, PM: pectoralis major muscle, Pm: pectoralis minor muscle.

Fig. 3.

Ultrasound view of the serratus anterior plane block with respect to the fourth rib. SM: serratus anterior muscle; LD: latissimus dorsi muscle; IC: intercostal muscles.

Fig. 4.

Ultrasound view of erector spinae plane block with resepct to the fifth thoracic transverse process (T5 TP). P: pleura, TM: trapezius muscle, RMM; rhomboid major muscle, ESM: erector spinae muscle.