Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block

Elsharkawy, Hesham; El‐Boghdadly, Kariem; Kolli, Sindhura; Esa, Wael Ali Sakr; DeGrande, Sean; Soliman, Loran Mounir; Drake, Richard L.

doi:10.1097/eja.0000000000000680

Cited by 138 publications

(114 citation statements)

References 26 publications

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“…This fascia is continuous throughout the cervical, thoracic and lumbar spine,18 19 which facilitates injectate spread 6. This study provides evidence that the fascial plane in the thoracic area deep to ES muscles, the target for ESP block, is in continuity caudally with the MTLF in the lumbar region posterior to the QL muscle, medially superficial to the laminae for the retrolaminar block and laterally with the tissue plane deep to the rhomboid and serratus anterior muscles for the rhomboid intercostal and subserratus block 20.…”

Section: Discussionmentioning

confidence: 99%

Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study

Elsharkawy

Bajracharya

El‐Boghdadly

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesBoth posterior quadratus lumborum (QL) and erector spinae plane (ESP) blocks have been described as new truncal interfascial plane blocks. Distribution of injectate is influenced by fascial anatomy; therefore, different injection sites may produce similar spread. This anatomic study was designed to test the hypothesis that a posteromedial QL block at L2 level will more closely resemble a low thoracic ESP block when compared with the posterolateral approach at L2 level.MethodsLeft-sided ESP blocks were performed in six cadavers at T10–11. Three of these cadavers received right-sided posteromedial QL block at L2, while the other three received right-sided posterolateral QL block at L2. All injections were composed of 20 mL methylcellulose 0.5 % mixed with India ink and 10 mL of Omnipaque (Iohexol) 240 mg/mL. CT 24 hours after injection and cadaver dissection were used to evaluate injectate spread.ResultsCephalocaudal spread of injectate by CT and cadaveric dissection was highly correlated (r=0.85 [95% CI 0.51 to 0.95]). Cadaver dissection showed ESP injectate spread deep to the muscle (mean [SD]) 11.7 (2.3) levels compared with 7.3 (1.2) levels for posterolateral QL and 9.7 (1.5) for posteromedial QL (p=0.04 overall, with a statistically significant pairwise difference between ESP and posterolateral QL only). The subcostal nerve and dorsal rami were commonly involved in most blocks, but the paravertebral space and ventral rami had inconsistent involvement. The lumbocostal ligament limited cranial spread from the posterlateral QL block approach.ConclusionsThe posteromedial QL block at L2 produces more cranial spread beyond the lumbocostal ligament than the posterolateral QL block, and this spread is comparable with a low thoracic ESP block. Both posterior QL and ESP blocks show unreliable spread of injectate to the paravertebral space and ventral rami, but the dorsal rami were frequently covered.

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Section: Discussionmentioning

confidence: 99%

Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study

Elsharkawy

Bajracharya

El‐Boghdadly

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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“…3B). [13][14][15] The tissue plane between the psoas major muscle and the QL muscle is one continuous tissue plane from L4 to the subcostal levels, and it is continuous cranially to the thoracic paravertebral space deep to the endothoracic fascia. [13][14][15] Biomechanical Properties of Fascia and the Hidden…”

Section: Continuity Of the Fascial System And Migratory Local Anestheticmentioning

confidence: 99%

Interfascial Plane Blocks

Elsharkawy

Pawa

Mariano

2018

Regional Anesthesia and Pain Medicine

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158

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Ultrasound-guided interfascial plane blocks are a recent development in modern regional anesthesia research and practice and represent a new route of transmission for local anesthetic to various anatomic locations, but much more research is warranted. Before becoming overtaken with enthusiasm for these new techniques, a deeper understanding of fascial tissue anatomy and structure, as well as precise targets for needle placement, is required. Many factors may influence the ultimate spread and quality of resulting interfascial plane blocks, and these must be understood in order to best integrate these techniques into contemporary perioperative pain management protocols.

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“…The lateral and posterior QL block provides more extensive analgesia compared to the posterior TAP block and can generate analgesia from T6-7 to L1 [75,76].…”

Section: Evidence and Clinical Applicationsmentioning

confidence: 99%

Ultrasound-guided truncal blocks for perioperative analgesia

Koh

Lee

2018

Anesth Pain Med

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Since the widespread introduction of ultrasound for assisting techniques used in anesthetic theatres, peripheral nerve blocks of the trunk have been used more frequently to produce analgesia and anesthesia for surgeries involving the thorax, abdomen, and lower extremities. The introduction of real-time ultrasound has allowed the peripheral nerves, planes, and plexuses of the trunk to be located more accurately and has improved the success rate of truncal blocks The widespread application of ultrasound in clinical anesthesiology has led to an increase in the number of practitioners performing peripheral nerve blocks of the trunk to produce analgesia and anesthesia for surgeries involving the thorax, abdomen, and lower extremities. The use of real-time ultrasound has allowed the peripheral nerves, planes, and plexuses of the trunk to be located more accurately and has improved the success rate of blocks. Compared to central neuraxial techniques, many types of truncal blocks are relatively easy to perform and have low side effect profiles. As a result, truncal blocks have been introduced to provide perioperative analgesia for surgeries involving the thorax and abdomen. The most frequently used truncal block techniques include the paravertebral block, intercostal block, pectoralis and serratus anterior block, rectus sheath block, transversus abdominis plane block, and ilioinguinal and iliohypogastric nerve blocks. Recently introduced techniques also include the quadratus lumborum and erector spinae plane blocks. To apply each block correctly and reduce the likelihood of related side effects and complications, the practitioner must have a thorough understanding of the anatomical region, optimal block positioning, and device selection and management.

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Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block

Cited by 138 publications

References 26 publications

Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study

Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study

Interfascial Plane Blocks

Ultrasound-guided truncal blocks for perioperative analgesia

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