The Use of Peripheral Nerve Blockade in Laparoscopic and Robotic Surgery: Is There a Benefit?

Abstract

Purpose of review: The purpose of this review is to synthesize recent literature investigating the use of regional anesthesia for minimally invasive surgery.

Recent findings: Recent studies investigating the use of newer peripheral nerve blocks such as erector spinae plane (ESP) and quadratus lumborum (QL) block are very limited. Evidence supporting the use of peripheral nerve blockade in laparoscopic or robotic surgery is very limited and of low-moderate quality. While transverse abdominal plane (TAP) block may decrease opioid and pain scores after laparoscopic cholecystectomy, bariatric surgery, and colorectal surgery, the benefit of the block in the presence of multimodal analgesia remains to be clarified. Unilateral paravertebral block may be beneficial for percutaneous nephrolithotomy. ESP and rectus sheath blockade may enhance analgesia in laparoscopic surgery, but the magnitude of this benefit may not be clinically relevant. Limited evidence supports the use of QL block in laparoscopic urologic surgery. There is insufficient recent evidence to support the use of TAP or QL block for laparoscopic gynecologic surgery.

Keywords: Acute pain; Enhanced recovery; Laparoscopic surgery; Minimally invasive surgery; Peripheral nerve block; Regional anesthesia; Robotic surgery.