Regional Anesthesia Techniques for Pain Management for Laparoscopic Surgery: a Review of the Current Literature

Abstract

Purpose of Review The field of regional anesthesia has evolved tremendously in the last 15 years. New anesthesia protocols for ambulatory surgery and enhanced recovery after surgery have been developed as well. The focus of these techniques and protocols has centered on patient satisfaction and pain control while minimizing the use of opioids. The field of ambulatory surgery and anesthesia continues to evolve, and regional anesthesia and its plane techniques are at the center of these changes. Recent Findings Recent research has shown that regional techniques contribute to better pain control and patient experience and may decrease patient readmission rates. The safety of these techniques has been validated when performed by experienced practitioners. New techniques such as the erector spinae block (ESP) have been studied in the setting of laparoscopic surgery with promising results. Summary Regional anesthesia techniques for patients presenting for laparoscopic surgery are safe and seem to provide benefits. Those are related to patient experience, pain control, and readmission rates. Different techniques can be applied to a specific type of intervention. Application of these techniques depend on the clinical picture and patient. Future research may help us clarify how these techniques may improve patient satisfaction and operating room efficiency. New regional blocks may also develop based on what we know today.

Postoperative Analgesic Effect of Dexamethasone Added To Ropivacaine for Fascia Iliaca Compartment Block Following Femoral Fracture Surgeries

“…15 The field of regional anesthesia has evolved tremendously in the last 16 years. 16 Regional anaesthesia and analgesia techniques are used to effectively manage acute pain after a variety of orthopedic surgeries. 17 The fascia-iliaca compartment block(FICB), first described in 1989, is easy to perform and is associated with minimal risk as the analgesic is injected at a safe distance from the femoral artery and femoral nerve.…”

Assessing Postoperative Analgesic Efficacy of Laparoscopic-Guided Ropivacaine Trocar-Site Infiltration

“…Furthermore, effective control of active pain after abdominal surgery is very important to ensure early activities and promote postoperative recovery. 2 We argue that no reporting of patients’ status would have confused the results of postoperative pain assessment in this study.…”

“…Most important, administration of a high dose opioid drug for postoperative pain control is not ideal for the successful use of enhanced recovery after surgery protocols, in which multimodal analgesia is required to limit opioid use during a hospital stay and improve postoperative recovery and outcomes of patients. 2 Second, the authors did not clearly describe the status of patients when postoperative pain was assessed at 6, 24, and 48 hours after surgery. It is generally believed that postoperative pain is more severe at active status than at resting status following laparoscopic surgery.…”

“…Most important, administration of a high dose opioid drug for postoperative pain control is not ideal for the successful use of enhanced recovery after surgery protocols, in which multimodal analgesia is required to limit opioid use during a hospital stay and improve postoperative recovery and outcomes of patients. 2…”

Pain treatment and prophylaxis on pain

“…spinal and epidural), as these may prolong time to postoperative mobilisation and discharge. Still, in patients with more than average pain risk, or laparoscopic procedures of more complexity and duration than usual, the use of different types of abdominal plane blocks may be appropriate, although the extra analgesia is modest [7,40,41]. Also, in some orthopaedic procedures with strong postoperative pain, for instance ankle surgery, a single shot block will provide good analgesia for the first hours after surgery.…”