Truncal blocks in ambulatory surgery: what is the evidence?

Truncal blocks are increasingly used in ambulatory pathways, although evidence predominantly concerns short-term inpatient outcomes. This review evaluates clinically important, procedure-specific benefits over realistic multimodal comparators.

Benefits are small and comparator-dependent. Trials comparing laparoscopic transversus abdominis plane and rectus sheath blocks with wound infiltration were neutral; quadratus lumborum block showed no clinically important superiority. Erector spinae plane block provides early analgesic signals, but heterogeneity and negative multicentre evidence limit generalizability. Evidence for pectoral and serratus plane blocks remains heterogeneous. Paravertebral block is more consistently effective but requires expertise, additional time, antithrombotic precautions, and observation. Only two randomized trials prespecified day-case or discharge endpoints.

Truncal blocks supplement multimodal analgesia rather than replace general anesthesia, except for selected small, superficial abdominal wall procedures. Transversus abdominis plane block has the largest, heterogeneous evidence base, but benefits over optimized infiltration are often small or absent. Evidence on discharge, recovery at home, and rebound pain remains insufficient. Despite efficacy in major breast surgery, paravertebral block is less suitable for routine day-case pathways because of procedural and monitoring requirements. Current evidence does not support recommending routine truncal blocks for intraoperative and postoperative analgesia in ambulatory surgery.