Fascial plane blocks in labor: promise or illusion? A narrative review with expert opinion.

Abstract

Background: Neuraxial analgesia represents the gold standard for labor pain management, providing superior efficacy and safety for both mother and fetus. However, its use is not always feasible due to medical contraindications, technical difficulties, or patient preference. Fascial Plane Blocks (FPBs) have emerged as potential alternatives, yet evidence regarding their effectiveness in labor remains limited. The purpose of this study was to synthesize the current evidence on FPBs for labor analgesia and to offer expert insight into their potential role, benefits, and limitations within modern obstetric practice.

Material and methods: A systematic search of PubMed, EMBASE, and the Cochrane Library (1985-2025) was conducted following PRISMA guidelines. Eligible studies included laboring women aged ≥ 18 years undergoing analgesia with FPBs. Case reports, case series, and letters to the editor were included due to the scarcity of high-level evidence. Outcomes of interest were maternal pain scores, analgesic satisfaction, and maternal-fetal safety. Because of the marked heterogeneity in study designs, interventions, and outcome measures, a meta-analysis was not feasible; therefore, a narrative synthesis was performed, and qualitative methodological assessment was undertaken using validated tools.

Results: Eight studies met inclusion criteria. QLB demonstrated promising analgesia in the first stage of labor, while lumbar and thoracic ESPBs yielded variable effects and inconsistent coverage during the second stage. Sacral ESPB showed potential as an adjunct when neuraxial techniques failed or were contraindicated. No major complications were reported; however, methodological limitations, small sample sizes, and inconsistent reporting hindered definitive conclusions. Fetal outcomes were rarely reported, and no long-term follow-up data were available.

Conclusions: Current evidence does not support FPBs as replacements for neuraxial analgesia. Their use should be restricted to highly selected cases where neuraxial techniques are not feasible. Importantly, there is no predefined formula for managing labor pain-analgesic strategies must be individualized according to clinical context, patient preference, and available resources. High-quality prospective studies are necessary to clarify the role of FPBs in labor.