Pain Management in Open Abdominal Aortic Aneurysm Repair: Potential Alternatives to Epidural Anesthesia

Despite significant advances in endovascular techniques, open abdominal aortic aneurysm (AAA) repair continues to play an important role in vascular surgery. Many studies have described the advantages of epidural anesthesia combined with general anesthesia over general anesthesia alone as an analgesic method for open AAA repair. Several recent guidelines have recommended epidural anesthesia as the first option for pain management in open AAA repair. However, AAA repair requires perioperative anticoagulation, and bleeding complications are an inevitable concern. In the past 2 decades, new methods of analgesia, represented by ultrasound-guided nerve blocks, have been developed and become popular in major abdominal surgery. These analgesic methods may address the concern of bleeding complications associated with epidural anesthesia in open AAA repair. Although the efficacy and safety of ultrasound-guided nerve blocks, continuous local wound infiltration, and intravenous administration of lidocaine in open AAA repair have been evaluated in several studies, few studies have evaluated the efficacy of continuous nerve blocks compared with epidural anesthesia. In this article, the authors present a narrative review of pain management techniques used in open AAA repair, focusing on pain management techniques other than epidural anesthesia. Research gaps and the need for further studies on this topic are also discussed.