Periferal nerve blocks in cessarian secction

Abstract

Cesarean section is the most frequent surgery in the world and postoperative pain is commonly reported as moderate to severe. Thus, timely multimodal analgesia, based on systemic agents and neuraxial hydrophilic opioids, is the current recommended standard. The role of peripheral nerve blocks has accumulated some evidence on this subject. The most published blocks are the transverse abdominis muscle plane blocks, the quadratus lumborum muscle plane blocks, and the most recently described, the erector spinae muscle plane block. More classic blocks, such as thoracic paravertebral or ilioinguinal-iliohypogastric nerve blocks, have limited evidence in comparison. To date, peripheral blocks neither replace nor add to the analgesic role of neuraxial opioids in cesarean surgery. However, there is room to investigate these blocks in specific scenarios. For instance, studies looking for the benefits of more lasting blocks, their role as rescue alternatives for cases still in pain after a standardized treatment, and their pertinence in patients with a high risk of severe pain becoming a chronic entity are granted. Regardless of the technique, but especially in fascial plane injections, the vulnerability to local anesthetics' systemic toxicity should be considered. Therefore, operators must follow the current guidelines for preventing and treating this complication.