• Lada Kalagac Fabris, Maša Biberić, and Siniša Zrna.
• Specialist in anesthesia, ICU and pain therapy Department of Anesthesiology, Intensive Medicine and Pain Therapy General Hospital Pula, Pula, Croatia.
• Acta Clin Croat. 2022 Sep 1; 61 (Suppl 2): 135144135-144.

AbstractThe aim of this review article is to introduce a newer approach to multimodal anesthesia. In addition to the usual combination of epidural catheter and general anesthesia as standard techniques in surgical procedures accompanied by intense postoperative pain, we want to encourage reflection on the application of various regional techniques in equally complex surgical conditions. By simply modifying the standard neuraxial technique with a higher thoracic approach, excellent abdominal surgery can be performed to awake the patient. However, placement of an epidural catheter is not always possible due to technical difficulties or patient-related conditions that contraindicate its insertion. Trunk-level fascia blocks (PVB, ESPB, RLB) are simple, safe alternative to an epidural catheter because the transverse process, which is the target of ultrasound, is easily visualized and the injection site is away from neuroaxis, pleura, and large vascular structures. In addition, extensive craniocaudal diffusion of anesthetics allows wide coverage with a single injection. It has been confirmed that PVB, ESPB, RLB blocks act on visceral and somatic pain. Therefore, their ultrasound-guided use in laparoscopic and other abdominal surgeries may be useful. With a well-designed fusion of regional techniques in operations of the upper and lower abdomen, it is possible to achieve hemodynamically and respiratory stable anesthesia in an awake patient with reduced postoperative pain.

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