Transversalis Fascia Plane Block

Indications and Clinical Considerations

Transversalis fascia plane block is useful in evaluating and managing lateral subcostal abdominal and groin pain. The technique also is useful in providing surgical anesthesia for iliac crest bone harvest, appendectomy, cecostomy, and inguinal hernia repair ( Fig. 118.1 ). It may serve as an adjunct to transversus abdominus plane block if more lateral anesthesia is required. Transversalis fascia plane block with local anesthetics can be used diagnostically during differential neural blockade on an anatomic basis when evaluating lateral subcostal abdominal pain groin to help distinguish abdominal wall pain from pain emanating from more the proximal T12 and L1 nerves and the ilioinguinal and iliohypogastric nerves.

Transversalis fascia plane block with local anesthetic may be used for palliation in acute pain emergencies, including postoperative pain relief following lateral abdominal and groin surgery and iliac crest bone harvest and inguinal hernia repair, during the wait for pharmacologic therapies to take effect. Transversalis fascia plane block with local anesthetic and steroids also is useful in treating persistent pain after lateral abdominal and inguinal surgery or abdominal wall trauma when the pain is thought to be secondary to inflammation. Pain of malignant origin involving the lateral abdominal wall and groin has been successfully managed by placing a catheter for continuous infusions of local anesthetics using this ultrasound-guided technique.