Analgesia for Upper Abdominal Surgery, a Scoping Review of the Current Fascial Plane Block Techniques

Effective pain management following upper abdominal surgery, particularly in the area between the lower costal margin and the umbilicus, remains a clinical challenge. The sixth to eleventh intercostal nerves provide sensory innervation not only to this area but also to the area directly below the umbilicus, and various regional anaesthesia techniques have been described to block these nerves and reduce postoperative pain. Over the past decade, several approaches have emerged that target these nerves within the relatively confined anatomical space between the anterior axillary line and the midline. This review explores the various techniques employed to block the lower intercostal nerves, focusing on the anatomical, sonographic, and technical considerations of each technique. Traditional and contemporary approaches to providing analgesia to the upper abdominal wall will be discussed. An understanding of the differences and/or similarities of the sono-anatomy of the target fascial planes is crucial for success when performing these blocks. Further research to identify the most effective and reliable regional techniques for upper abdominal surgery is still needed.