Fascial plane blocks: TAP, ESP, and QL

Model answer

Block choice (4). Bilateral TAP or QL for abdominal wall somatic cover (taught matching); ESP if thoracic extension/trunk plan needed — Forero described ESP for thoracic neuropathic pain in 2 cases with extensive multidermatomal block, likely site dorsal and ventral rami on cadaver investigation; set expectation that visceral pain needs systemic multimodal.^[1]

Technique/dose (4). Ultrasound guidance with real-time spread monitoring (taught planes); large-volume dilute LA per side within max dose — exact volumes per local protocol; recalculate bilateral totals; incremental injection.^[2]

LAST (3). Lipid emulsion ready; know ASRA checklist pathway for seizure/CV collapse; small patient size and sarcopenia add risk, and presentation may be delayed with infusions.^[2][3]

ERAS multimodal (4). Paracetamol ± NSAID, opioid rescue/PCA, antiemetics, mobilisation; rescue plan if incomplete block — taught adjunct role, not an epidural equivalent.^[1]