Postoperative Analgesia Techniques in Abdominal Surgery

Effective management of postoperative pain following abdominal surgery is essential for optimising recovery, reducing complications and enhancing patient satisfaction. Traditional systemic opioids, while potent, carry risks of nausea, sedation and respiratory depression. Consequently, multimodal regimens combining non-opioid analgesics, local anaesthetics and regional techniques have gained prominence. Neuraxial methods such as epidural analgesia remain the gold standard for major open procedures, offering dense sensory blockade and sympathetic modulation but requiring careful haemodynamic monitoring. In parallel, ultrasound-guided abdominal wall blocks—including transversus abdominis plane (TAP), quadratus lumborum (QL) and rectus sheath approaches—have become widespread. These regional blocks deliver local anaesthetic adjacent to specific nerve distributions, reducing opioid requirements and facilitating early mobilisation. Advances such as liposomal formulations extend block duration, while pharmacokinetic insights into agents like ropivacaine help tailor dosing in patients with altered physiology. Integration of these techniques within enhanced recovery pathways supports quicker return of bowel function, shorter hospital stays and lower overall morbidity.

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Postoperative Analgesia Techniques in Abdominal Surgery publication trend

The graph below shows the total number of articles in postoperative analgesia techniques in abdominal surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Epidural analgesia: Regional technique delivering local anaesthetic into the epidural space to block spinal nerve roots for dense pain relief and sympathetic modulation.

Transversus abdominis plane block: Ultrasound-guided injection of local anaesthetic between the internal oblique and transversus abdominis muscles to anaesthetise the anterolateral abdominal wall.

Quadratus lumborum block: Ultrasound-guided deposition of local anaesthetic adjacent to the quadratus lumborum muscle to achieve broader somatic and visceral analgesia for abdominal procedures.

Ropivacaine: A long-acting amide local anaesthetic with reduced cardiotoxic and central nervous system side effects, used extensively in regional blocks.

Alpha-1 acid glycoprotein (AAG): Acute-phase plasma protein that binds amide local anaesthetics, influencing free-drug concentrations and toxicity risk.

References

1. Altered Pharmacokinetics of Ropivacaine in Patients Undergoing Laparoscopic Major Hepatectomy. Pharmaceutics (2025).
2. Analgesic effect of the ultrasound-guided subcostal approach to transmuscular quadratus lumborum block in patients undergoing laparoscopic nephrectomy: a randomized controlled trial. BMC Anesthesiology (2019).
3. A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy. BMC Anesthesiology (2019).
4. Comparison of Transversus Abdominis Plane Infiltration with Liposomal Bupivacaine versus Continuous Epidural Analgesia versus Intravenous Opioid Analgesia. PLOS ONE (2016).