Trunk Blocks 101: Transversus Abdominis Plane, Ilioinguinal Iliohypogastric, and Rectus Sheath Blocks

RA is useful for many ambulatory surgical procedures, and trunk blocks are no exception. Few abdominal procedures can be performed by using the trunk blocks (in isolation) described above for a primary anesthetic because of the lack of visceral anesthesia and analgesia; some procedures can be, however, when combined with an effective intravenous multimodal technique (eg, propofol with low-dose ketamine). Many procedures can benefit from the use of trunk blocks for providing postoperative analgesia, decreasing opioid requirements, postoperative nausea and vomiting, and hastening discharge from the recovery area (if not even achieving bypass of the Phase I postanesthesia care unit). In the past, trunk blocks had a reputation for being inconsistently effective. This is not surprising, given the variability in anatomy of the nerves of the abdominal wall, and the difficulty verifying endpoints for needle placement when using traditional, landmark-based techniques. With the more recent development and refinement of US-guided RA techniques, anatomical variation is more easily identified, and accurate needle placement is more consistently achieved when performing trunk blocks. US guidance may also help prevent complications brought on by incorrect needle placement, such as peritoneal/visceral puncture, intravascular injection, or nerve injury. US guidance may not necessarily reduce the risks of infection from needle puncture, except potentially by reducing overall procedural times when compared with landmark-based techniques. © 2012, Lippincott Williams & Wilkins.