Anatomical and ultrasound description of two transmuscular quadratus lumborum block approaches at L2 level and their application in abdominal surgery

Abstract

The transmuscular quadratus lumborum (TQL) block is one of the recently evolved myofascial blocks utilised in abdominal surgery. It involves injecting local anaesthetic into the fascial plane anterior to the thoracolumbar fascia. This block has previously been described with a transverse oblique paramedian approach at the L2 level in the sitting position. We describe a TQL block at the same level in the lateral position using a transverse posterolateral approach to provide analgesia for patients undergoing abdominal surgery. We elaborate on these two approaches of TQL block at the L2 level, in relation to the anatomy, sonoanatomy and technical aspects.

Transmuscular Quadratus Lumborum Block versus Infrainguinal Fascia Iliaca Nerve Block for Patients Undergoing Elective Hip Replacement: A Double-blinded, Pilot, Randomized Controlled Trial

“…TQLB works at the paravertebral level, preferentially blocking lower thoracic segments while the caudad spread is limited to the iliac crest. 7 , 19 We believe this can provide analgesia to the hip area but may not significantly cause quadriceps weakness which is supplied by L3, 4, 5. In contrast fascia iliaca block consistently causes quadriceps weakness 4 , 20 with incidence up to 4%.…”

New Kid on the Block: A Systematic Review of the Quadratus Lumborum Block in Plastic and Reconstructive Surgery

“…Type 3 is an anterior or trans-muscular approach, which targets the plane between the psoas major and QL muscle, and type 4 is an intramuscular injection directly into the QL muscle. 24 , 34 The type 1 block has been described to cover a T12-L1 dermatome, making it an effective block for surgery below the umbilicus. Type 2 and 3 QL blocks cover a wider dermatomal distribution, from T7-L1, making them useful in procedures that involve the abdomen above the umbilicus.…”