Anaes · Regional anaesthesia
Fascial plane blocks: TAP, ESP, and QL
Also known as TAP block · Erector spinae plane block · Quadratus lumborum block · Abdominal wall blocks ERAS
Exam-pass fascial plane blocks: TAP, ESP, and QL indications, ultrasound landmarks, typical volumes, LAST risk, ERAS role, and failure/rescue strategy for ANZCA Final and equivalents.
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Red flags
- Large-volume bilateral plane blocks can approach LAST toxicity — calculate max dose before you draw up.
- Wall block ≠ visceral analgesia — patients still need multimodal cover for organ pain.
- Incoagulable patient + deep plane/catheter: apply ASRA timing principles, not heroics.
- Intraperitoneal injection and vessel puncture are real — watch spread on ultrasound.
- Overselling plane blocks as epidural replacements loses examiner trust.
Meet the patient
A sixty-year-old is listed for an open right hemicolectomy on an enhanced-recovery pathway, and the acute-pain team proposes bilateral TAP blocks plus local infiltration instead of a thoracic epidural. The surgeon asks whether that is enough, and the honest answer is one examiner is listening for: the wall will be numb, the viscera will not — taught coverage limit; [1] owns only the ESP description, not TAP indications.[1]
Plane blocks dominate modern acute-pain and ERAS vivas because they are common, high-volume, and LAST-relevant, and because candidates chronically oversell them. The examiner wants the coverage limits, the volumes, the LAST readiness, and a Plan B for when the wall is numb but the patient still hurts — taught viva framing within the LAST-checklist scope.[3]
References4ShowHide
- [1]Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med, 2016.PMID 27501016
- [2]Neal JM, Barrington MJ, Fettiplace MR, et al. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017. Reg Anesth Pain Med, 2018.PMID 29356773
- [3]Neal JM, Neal EJ, Weinberg GL American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version. Reg Anesth Pain Med, 2021.PMID 33148630
- [4]Marhofer P, Greher M, Kapral S Ultrasound guidance in regional anaesthesia. Br J Anaesth, 2005.PMID 15277302