New Regional Anaesthesia Fascial Blocks: Trans-Muscular Quadratus Lumborum Block and Erector Spinae Block in Postoperative Pain Management in Colonic Surgery

Abstract

Post-operative pain management is a key element of enhanced recovery after surgery (ERAS) during elective surgery. This PhD program focused on the new myo-fascial blocks in managing peri-operative pain. The program also focused on simplifying the description of performing the regional block under ultrasound guidance, including illustrated diagrams with coloured images. This thesis is composed of five chapters: Chapter 1 - Literature search on new fascial plane blocks. Chapter 2 - Anatomical and ultrasound description of two trans-muscular quadratus lumborum block (TQL) approaches and its application in abdominal surgery, and clinical use of these new techniques at L2 or L4 levels with catheter insertion for post-operative analgesia in open abdominal surgery. Chapter 3 - A prospective randomized study comparing the ultrasound guided TQL catheter technique with a surgical pre-peritoneal catheter for post-operative analgesia in abdominal surgery. To investigate the incidence of acute kidney injury (AKI) in this surgical population, we retrospectively studied AKI during the peri-operative period. Chapter 4 - Comparison of ultrasound guided erector spinae plane (ESP) block versus wound infiltration (WI) for post-operative analgesia in laparoscopic colonic surgery in a prospective randomised study. This chapter also includes an observational study of plasma ropivacaine levels after an ESP block. Chapter 5 - Conclusion and future directions for perioperative pain management strategies in colonic surgery.