Fascial plane blocks: TAP, ESP, and QL

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 the one the examiner is listening for: the wall will be numb, the viscera will not.[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.[3]

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1. [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. [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. [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. [4]Marhofer P, Greher M, Kapral S Ultrasound guidance in regional anaesthesia Br J Anaesth, 2005.PMID 15277302