Newer fascial plane blocks

Question 1

What Are Fascial Plane Blocks?

Answer 1

Regional anaesthesia techniques where local anaesthetic is deposited into fascial planes, allowing it to spread to nearby nerves. Used for postoperative analgesia, especially in thoracoabdominal and pelvic surgeries.

Question 2

What is the ESP block used for?

Answer 2

Thoracic/lumbar analgesia, spine, breast, abdomen.

Question 3

What is the PENG block used for?

Answer 3

Hip fracture & arthroplasty – blocks articular branches.

Question 4

What is the QL block used for?

Answer 4

Abdominal surgery – visceral + somatic analgesia.

Question 5

What is the IPACK block used for?

Answer 5

Post-TKR – posterior knee pain.

Question 6

What is the TLIP block used for?

Answer 6

Spine surgery – dorsal rami analgesia.

Question 7

What are the clinical implications of newer fascial plane blocks?

Answer 7

1. Improved Multimodal Analgesia: Reduces opioid consumption → less nausea, sedation, ileus.
2. Simpler, Safer Techniques: Most are ultrasound-guided, superficial, and low-risk (avoiding major vessels or nerves).
3. Enhanced Recovery: Useful in ERAS protocols for faster ambulation and discharge, especially in orthopaedic, abdominal, and oncologic surgeries.
4. 4. Visceral and Somatic Pain Control: Some blocks (like QL, ESP) reach paravertebral/plexus zones, covering visceral afferents.

Question 8

What are the limitations of fascial plane blocks?

Answer 8

1. Incomplete coverage compared to neuraxial blocks.
2. Skill-dependent and requires ultrasound proficiency.
3. Not yet widely standardized or included in all guidelines.