A lumbar anterior lateral transverse-process (LALaT) block for a patient with multiple traumatic injuries

The novel “anterior passage” sub-longissimus-thoracis plane block for lumbar spine surgery: a technical report

“…(Fig. 1-C) [1] In an anterior-to-posterior direction, the needle is advanced in-plane, through the latissimus dorsalis muscle, puncturing the skin 3-3 cm posteriorly to the anterior axillary line at L3 level, towards the plane between the psoas major muscle (PMM) and quadratus lumborum muscle (injection site of the QLB type 5) (Fig. 1-D), [2] then it is advanced further through the PMM to reach the TP/ intertransverse ligament (ITL) (injection site of the LALaT block) (Fig.…”

“…1-D), [2] then it is advanced further through the PMM to reach the TP/ intertransverse ligament (ITL) (injection site of the LALaT block) (Fig. 1) [1]; at this point, crossing the ITL, the sub-longissimus-thoracis plane (SLoP) is reached (if bony contact with lateral TP is noted the needle should be moved caudally or cranially, and afterwards advanced to the SLoP). During injection the LA is observing dissecting the SLoP.…”

“…All rights reserved. [1]; 2) the Lumbar Anterior Lateral Transverse-process (LALaT) block [2] 3) the "anterior passage" SLoP block -that should be used for lumbar spine surgery might be named "Anterior-Passage Lumbar" Blocks (Fig 1-A,B): they target injection sites planes located in the close vicinity of each other, but lead to completely different dispersion patterns.…”

“…The "Anterior Passage" SLoP block, acting directly through the sub-ESP, should provide at least spinal analgesia comparable to other lumbar ESP techniques, and potentially would minimize the blockade of the anterior branches of the lumbar plexus. [1] The ESP block will act mostly in the posterior rami of the spinal nerves (that innervate the posterior components of the vertebrae, nevertheless the post-operative neurologic check may be affected due to some thoracic "ventral" spread. [2][3][4] In a study, using magnetic resonance imaging, 30 ml of local anesthetic (LA) injected in the ESP at Th 10 level spread towards the ventral rami of spinal nerves, including epidurally in some patients, which could interfere with the post-operative neurologic check, carry risk of fall and sympathetic block.…”

Point-of-care transthoracic echocardiography: An essential management tool for acute massive pulmonary thromboembolism

“…Herein, a transthoracic echocardiographic image (four-chamber view) [Figure 1a and b ] from a hip fracture surgery patient aged >90 years old is presented, without significant previous medical history. After admission in the post-anesthesia care unit (PACU), the patient developed arterial oxygen de-saturation and type 2 respiratory insufficiency after a hip hemi-arthroplasty under general anesthesia (spontaneous ventilation) combined with lumbar anterior–lateral transverse-process block,[ 1 ] which went uneventfully (without significant alteration in the end-tidal CO 2 ). Initially, in the PACU, she maintained hemodynamical stability, but suddenly, the mean arterial pressure was undetectable and the patient developed asystolic cardiac rhythm.…”