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Do Outcomes Differ Between Thoracic Epidurals and Continuous Fascial Plane Blocks in Adults Undergoing Major Abdominal Surgery?

  • Anesthesia, Pain Management and Long-term Outcomes (VNR Gottumukkala and ER Mariano, Section Editors)
  • Published:
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Abstract

Purpose of Review

The thoracic epidural has historically been regarded as the gold standard for the management of post-operative pain in patients undergoing major abdominal surgery. However, it is not without risk, and there are several circumstances in which it is contraindicated. The advent of ultrasound-guided fascial plane blocks has expanded our options in the provision of post-operative analgesia. This narrative review examines the evidence comparing their use against the thoracic epidural in major open abdominal surgery.

Recent Findings

The most common fascial plane blocks used in comparison to thoracic epidurals are rectus sheath blocks, transversus abdominis plane blocks, quadratus lumborum plane blocks, and erector spinae plane blocks. The current evidence demonstrates that these regional techniques can provide a viable alternative to thoracic epidurals for short-term post-operative outcomes and analgesia. However, there have been few studies looking at any long-term outcomes.

Summary

There is a growing number of alternative fascial plane blocks which can provide effective post-operative analgesia as an alternative to thoracic epidurals, especially when patients have contraindications for epidural insertion. Further research is warranted looking at the potential role regional anesthesia has on long-term outcomes for this group of surgical patients.

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    Anthony Carver, Franklin Wou & Amit Pawa

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Carver, A., Wou, F. & Pawa, A. Do Outcomes Differ Between Thoracic Epidurals and Continuous Fascial Plane Blocks in Adults Undergoing Major Abdominal Surgery?. Curr Anesthesiol Rep 14, 25–41 (2024). https://doi.org/10.1007/s40140-023-00594-w

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