Anesthetic Techniques and Postoperative Pain Control

Postoperative pain is a frequently underestimated complication after diastasis recti abdominis (DRA) repair, significantly influencing surgical outcome and patient satisfaction; moreover an effective pain control reduces complications and hospital length of stay. Traditionally, opioids have been used to manage postoperative pain, but their adverse effects, including sedation, respiratory depression, nausea, vomiting, ileus, and delirium, necessitate alternative approaches. The Enhanced Recovery After Surgery (ERAS) guidelines recommend multimodal, opioid-sparing analgesia to facilitate early mobilization and bowel function recovery. Neuraxial anesthesia, particularly thoracic epidural analgesia (TEA), offers effective pain control for abdominal surgery and reduces surgical stress responses. However, TEA carries risks such as hypotension, fluid overload, urinary retention, and spinal epidural hematoma. Consequently, conservative use of neuraxial techniques is recommended, especially in patients receiving anticoagulant and antiplatelet drugs. Abdominal wall blocks, such as transversus abdominis plane (TAP) block, rectus sheath block (RSB), quadratus lumborum (QL) block, and erector spinae plane (ESP) block, provide an alternative by spreading local anesthetic within fascial planes to anesthetize multiple small nerves or plexuses. These blocks are technically straightforward and relatively safe, also in patients receiving anticoagulants and antithrombotic drugs, reducing pain and opioid requirements. In summary, abdominal wall blocks, which are described in detail in this chapter, are a safer, effective alternative to neuraxial anesthesia for postoperative pain control in DRA repair, enhancing recovery and aligning with ERAS guidelines.