Can a single-shot abdominal wall nerve block for unexpected open surgery be done without specific consent?

Abstract

Abdominal wall blocks are simple and safe opioid-sparing adjuncts for abdominal procedures that are generally well tolerated. These blocks have been shown to be effective for open abdominal surgeries, though their utility in laparoscopic or robotic surgery has been questioned. The unanticipated conversion from laparoscopic to open surgery may pose a challenge for the anesthesiologist, if regional anesthesia was not discussed before the start of the case as part of the pain-control regimen. Inability to offer an abdominal wall block leads to increased use of opioid medications and less-than-ideal analgesia during emergence and the immediate postoperative period, often until consent can be obtained and a nerve block offered. In this discourse, we discuss if a single-shot abdominal wall block is within the scope of a typical general anesthetic or if specific consent is needed prior to performance.

Keywords: Acute Pain; ETHICS; Nerve Block; Pain, Postoperative.