The Role of Truncal Blocks in Obstetric Anesthesia

Abstract

This review provides a framework for managing post-cesarean delivery pain in the age of enhanced recovery after surgery (ERAS). In doing so, it highlights the role that truncal blocks play in obstetric anesthesia. The value of transversus abdominus plane block (TAP) and quadratus lumborum block (QLB) to optimize post-cesarean delivery pain is discussed. TAP block and QLB have been compared with each other and with controls, with and without neuraxial morphine. In the absence of neuraxial morphine, TAP block and QLB are superior to controls, but when intrathecal morphine is used, they do not provide additional benefit. There is indeed a role for truncal blocks in obstetric anesthesia. Both TAP block and QLB provide analgesia after cesarean delivery. They are not, however, universally beneficial; they are best incorporated when neuraxial morphine is not used, or to rescue pain not well-controlled with standard multimodal analgesia.