Wisconsin Anesthesia Professionals

Nerve Blocks in the Abdomen

Nerve blocks in the abdomen target specific nerves or plexuses to provide analgesia for abdominal surgeries or pain conditions. These blocks are increasingly used as part of multimodal analgesia to reduce opioid consumption, enhance recovery, and minimize systemic side effects. Depending on the location and surgical procedure, different abdominal wall blocks or deeper plexus blocks may be employed 1.

Understanding the anatomy of abdominal innervation is essential for selecting and administering nerve blocks in the abdomen. The anterior abdominal wall is primarily supplied by the lower thoracic nerves (T6–T12) and the first lumbar nerve (L1). These nerves course between the internal oblique and transversus abdominis muscles before supplying the skin and musculature. For deeper visceral structures, autonomic plexuses such as the celiac, superior mesenteric, and hypogastric plexuses are involved. Blocks targeting somatic nerves relieve incisional pain, while those aimed at autonomic fibers are used for visceral pain relief 2.

Several interfascial plane blocks are routinely used in abdominal procedures. The transversus abdominis plane block targets nerves in the neurovascular plane between the internal oblique and transversus abdominis muscles, providing analgesia to the anterior abdominal wall from T6–L1. The rectus sheath block is used to anesthetize the terminal branches of the lower thoracic nerves located within the rectus sheath, particularly effective for midline incisions. The ilioinguinal–iliohypogastric block, meanwhile, targets nerves that supply the lower abdomen and groin, useful in hernia repairs 3–6.

For upper abdominal or visceral pain, deeper nerve blocks are indicated. The celiac plexus block involves injecting local anesthetic around the celiac plexus located near the aorta at the level of T12–L1. It is used for managing intractable abdominal cancer pain or chronic pancreatitis. The quadratus lumborum block has emerged as a more effective alternative to transversus abdominis plane blocks for broader and deeper analgesia, with local anesthetic spreading to the thoracic paravertebral space. In addition, an erector spinae plane block performed at thoracic levels can provide extended visceral and somatic analgesia across multiple dermatomes 7–10.

Ultrasound guidance has significantly enhanced the safety and efficacy of nerve blocks in the abdomen by enabling real-time visualization of anatomical structures, needle trajectory, and local anesthetic spread. This has reduced the risk of complications such as vascular puncture, organ injury, or local anesthetic systemic toxicity. Proper patient positioning, aseptic technique, and dosing are critical to successful outcomes, but block effectiveness can vary based on anatomical variation and operator experience 11–13.

Abdominal nerve blocks are utilized in a variety of clinical settings including cesarean sections, laparoscopic procedures, bowel resections, and chronic pain syndromes. They reduce the need for systemic analgesics, improve postoperative mobility, and may even shorten hospital stays. In enhanced recovery following surgery protocols, abdominal blocks play a key role in optimizing pain control while minimizing opioid-related side effects 14,15.

Nerve blocks in the abdomen are valuable tools in both acute surgical and chronic pain management. With proper anatomical understanding and ultrasound-guided technique, these regional anesthesia methods offer safe, targeted, and effective analgesia, enhancing patient comfort and recovery in a wide range of abdominal interventions.

References

  1. Mavarez, A. C., Hendrix, J. M. & Ahmed, A. A. Transabdominal Plane Block. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
  2. Kudzinskas, A. & Cunha, B. Anatomy, Anterolateral Abdominal Wall Nerves. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
  3. Ilioinguinal/Iliohyprogastric Nerve Block. https://usra.ca/regional-anesthesia/specific-blocks/trunk/ilioinguinalnerve.php.
  4. Ilioinguinal/iliohypogastric block | European Society for Paediatric Anaesthesiology. https://www.euroespa.com/science-education/specialized-sections/espa-pain-committee/us-regional-anaesthesia/truncal-blocks/ilioinguinaliliohypogastric-block/.
  5. NYSORA. Rectus Sheath Block in 4 Steps. NYSORA https://www.nysora.com/general/rectus-sheath-block-in-4-steps/ (2022).
  6. Transversus Abdominis Plane Block: Background, Indications, Contraindications. https://emedicine.medscape.com/article/2000944-overview?form=fpf.
  7. Krishnan, S. & Cascella, M. Erector Spinae Plane Block. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
  8. John, R. S., Dixon, B., Hendrix, J. M. & Shienbaum, R. Celiac Plexus Block. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
  9. Celiac Plexus Block: What Is It? Cleveland Clinic https://my.clevelandclinic.org/health/treatments/16853-celiac-plexus-block.
  10. Dhanjal, S. T. & Tonder, S. Quadratus Lumborum Block. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
  11. Brown, J. R. et al. Ultrasound-Guided Nerve Blocks: Suggested Procedural Guidelines for Emergency Physicians. POCUS J 7, 253–261. DOI: 10.24908/pocus.v7i2.15233
  12. Herring, A. A., Stone, M. B. & Nagdev, A. D. Ultrasound-guided abdominal wall nerve blocks in the ED. Am J Emerg Med 30, 759–764 (2012). DOI: 10.1016/j.ajem.2011.03.008
  13. Operater. Ultrasound-Guided Transversus Abdominis Plane and Quadratus Lumborum Nerve Blocks. NYSORA https://www.nysora.com/topics/abdomen/ultrasound-guided-transversus-abdominis-plane-quadratus-lumborum-blocks/ (2018).
  14. Mavarez, A. C., Hendrix, J. M. & Ahmed, A. A. Transabdominal Plane Block. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
  15. Young, M. J., Gorlin, A. W., Modest, V. E. & Quraishi, S. A. Clinical Implications of the Transversus Abdominis Plane Block in Adults. Anesthesiol Res Pract 2012, 731645 (2012). DOI: 10.1155/2012/731645