Ultrasound Blocks for the Anterior Abdominal Wall

9. Obstetric and Gynecologic Surgery | 75
9. Obstetric and Gynecologic Surgery
Zhirajr Mokini
Anterior abdominal wall blocks have been evaluated in
gynecologic and obstetric surgery. The Pfannenstiel section for
open gynecologic and obstetric surgery affects the groin
territory innervated by IIH and IIN. Obviously, a bilateral block is
required in these types of surgery. Multimodal analgesia with
anterior abdominal wall regional blocks applied to laparoscopic
or open intra-abdominal surgery seem to be particularly useful
in reducing postoperative opioid requirements (Bamigboye
2009). A recent survey among obstetric anesthesiologists in the
United Kingdom showed that 21.6% of them used TAPB for
cesarean sections (Kearns 2011).
It is important however to provide patients with adequate
analgesia in relation to the surgical procedure because blocks
cannot offer visceral pain control. Objective evaluation in terms
of pain reduction may be difficult because the visceral
component of postoperative pain may be subjectively described
as moderate to severe. This is why many studies report
significant reduction in opioid requirements without significant
differences in pain scores. Visceral pain can be effectively
relieved with neuraxial or systemic opioid administration, but at
the price of uncomfortable side effects (Kanazi 2010).