Dermatomal coverage of single-injection ultrasound-guided parasagittal approach to anterior quadratus lumborum block at the lateral supra-arcuate ligament

Shi, Rong; Li, Huili; Wang, Yun

doi:10.1007/s00540-021-02903-1

Cited by 15 publications

(19 citation statements)

References 11 publications

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“…The lowest edge of the diaphragm was considered as the lateral arcuate ligament. 8,9 The continuity of the lateral arcuate ligament with the ATF also could be observed in the sonogram (Figure 2B and Video 1). The QL muscle was shown as the hypoechoic or isoechoic structure posterior to the diaphragm (Figure 2B).…”

Section: Resultsmentioning

confidence: 62%

“…The total ultrasound visibility of the three structures was determined to be good if the mean total visibility score was >6, average if the score was 3-6, and poor if the score was <3. 6,8 2-3 mL of 1% lidocaine was injected into the skin 2 cm caudal to the ultrasound probe for local infiltration. A 18 G puncture needle (TUOREN, Henan, China) was next inserted in the plane of the ultrasound beam such that its tip was oriented towards the target injection site below the lateral arcuate ligament and between the ATF and the investing fascia of QL muscle (Figure 1).…”

Section: Dovepressmentioning

confidence: 99%

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A Modified Approach Below the Lateral Arcuate Ligament to Facilitate the Subcostal Anterior Quadratus Lumborum Block

Shi

Wang

2021

JPR

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Purpose The subcostal quadratus lumborum (QL) block was used in postoperative analgesia for abdominal surgery. However, it is difficult to precisely put the needle tip into the target fascia compartment. In the current study, we proposed a modified approach to facilitate the subcostal QL block. Patients and Methods Twenty-four patients scheduled for laparoscopic renal surgery were enrolled. The modified QL block was placed preoperatively. The transducer was placed just laterally to the tip of L1 transverse process to perform the parasagittal scan. The needle was inserted in-plane and advanced toward the target compartment between the QL muscle and the anterior thoracolumbar fascia and just below the lateral arcuate ligament. The 20 mL of 0.5% ropivacaine was injected slowly if the saline spread cranially via the posterior pathway of lateral arcuate ligament was observed on the sonogram. Then, the paramedian transverse scanning at the level of T12-L1 was performed to observe the injectate diffusion. The dermatomal coverage of sensory block was tested at 5 min and 10 min after LA injections. The complications associated with the block were recorded. Results Twenty-three (95.8%) patients received the successful block. All patients achieved the sensory block dermatomes of T9–T12 and T6–L1, at 5 and 10 minutes after injection, respectively. The mean numbers of block dermatomes were 5.6±1.8 at 5 min and 6.5±2.2 at 10 min after injection. Two out of twenty-three (8.7%) patients achieved coverage as cephalad as T5 at 10 min after injections. The lunar-shaped spread of LA along the diaphragm into the T12 paravertebral space was observed in every patient. No complications occurred. Conclusion The modified subcostal QL block has the advantages of clear sonoanatomy, rapid onset time, and consistent dermatomal coverage and provides a new choice for postoperative analgesia of abdominal surgery. Trial Registration Chinese Clinical Trial Registry: ChiCTR2000029210.

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Section: Resultsmentioning

confidence: 62%

Section: Dovepressmentioning

confidence: 99%

A Modified Approach Below the Lateral Arcuate Ligament to Facilitate the Subcostal Anterior Quadratus Lumborum Block

Shi

Wang

2021

JPR

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“…Clinical studies have found that supra-arcuate ligament blocks have rapid onset (<5 minutes), long maintenance times (24–48 hours), and little effect on hemodynamic. 5 , 22 Unilateral supra-arcuate ligament blocks can be used for surgical anesthesia and postoperative analgesia in lateral abdominal and retroperitoneal organ surgeries, while bilateral supra-arcuate ligament blocks can provide surgical anesthesia and postoperative analgesia for total abdominal surgery. 25 , 26 Although a comprehensive understanding of a supra-arcuate ligament block has been obtained in clinical application, there is still much to learn about the drug diffusion pattern, which needs further cadaver or radiographic studies.…”

Section: Discussionmentioning

confidence: 99%

“…The dermatomal coverage of sensory block can be detected between T6-7-L1-2 by ice cube method at 10 minutes after block. 22 The associated complications include diaphragm injury, neuraxial injection, and abdominal visceral injury, etc.…”

Section: The Implementation Of Supra-arcuate Ligament Blocksmentioning

confidence: 99%

Supra-Arcuate Ligament Blocks: Anatomy, Mechanisms, and Techniques

Li¹,

Liang²,

Shao³

et al. 2021

JPR

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Quadratus lumborum block (QLB) is clinically used for postoperative analgesia of abdominal or hip surgery, which can reduce the dose of general anesthetic, inhibit postoperative pain, and promote postoperative rehabilitation. However, accumulated studies have shown several drawbacks of QLB, such as only a small portion of local anesthetic spread into the thoracic paravertebral space, relatively longer onset time, and easily-influenced block effect by the integrity of lumbar fascia, etc. Therefore, on the basis of traditional anterior QLB, our group proposed the techniques of a supra-arcuate ligament block, which include a paramedian short-axis scanning approach, paramedian long-axis scanning approach, infra-lateral arcuate ligament QLB with the apposition zone between diaphragm and quadratus lumborum as drug diffusion target and supra-arcuate ligament block under direct laparoscopic visualization. Recent studies have demonstrated that the supra-arcuate ligament blocks have the advantages of clear anatomy, are easy to perform, and have rapid onset, which avoid some drawbacks of the conventional QLB techniques. This article reviews the anatomical basis, sonoanatomy, technical points, and clinical considerations of supra-arcuate ligament blocks.

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“…The subcostal approach to the QL block reported by Elsharkawy et al has shown extensive sensory block between T6-7 and L1-2 by moving the injection site more cephalad, to just below the 12th rib [13]. The parasagittal approach at the lateral supra-arcuate ligament reported by Shi et al was a modified anterior approach aimed at directing the injectate into the lower thoracic PVS [14]. There is not yet enough data on the safety and efficacy of these cephalad approaches.…”

mentioning

confidence: 99%

Development and modification of new fascial plane blocks

Hotta

2021

J Anesth

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Dermatomal coverage of single-injection ultrasound-guided parasagittal approach to anterior quadratus lumborum block at the lateral supra-arcuate ligament

Cited by 15 publications

References 11 publications

A Modified Approach Below the Lateral Arcuate Ligament to Facilitate the Subcostal Anterior Quadratus Lumborum Block

A Modified Approach Below the Lateral Arcuate Ligament to Facilitate the Subcostal Anterior Quadratus Lumborum Block

Supra-Arcuate Ligament Blocks: Anatomy, Mechanisms, and Techniques

Development and modification of new fascial plane blocks

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