Quadratus Lumborum block as primary anesthetic technique for colostomy procedure: a case report

Successful Use of Ultrasound Guided Quadratus Lumborum Block Without General Anesthesia for Open Appendectomy in a Patient with Heart Failure with Reduced Ejection Fraction- A Case Report and Literature Review

“…Local infiltration with 6mL of 0.25% bupivacaine prior to incision Postoperative analgesia with paracetamol and pregabalin 100 mg overnight Balogh et al 16 Open umbilical Hernia repair (case 1) CM with EF of < 10%, CAD, end stage liver disease and CKD Injectate given bilaterally into the lateral interfascial triangle behind QL muscle (QLB type 2) 20 mL of 0.5% ropivacaine 1 mg of i.v midazolam prior to block followed by 0.1 mcg/kg/min of remifentanil infusion Multimodal modal analgesia (acetaminophen, gabapentin and tramadol) Balogh et al 16 Open repair of incarcerated ventral hernia (case 2) CM with an EF< 10%, CAD, COPD, End stage renal disease, HTN, history of cocaine abuse Injectate given bilaterally into the lateral interfascial triangle behind QL muscle (QLB type 2) 20 mL of 0.5% ropivacaine Sedation with 0.1 mcg/kg/min infusion of remifentanil and 0.04 mcg/kg/hr of dexmedetomidine Not reported Mohan et al 19 Open repair of left inguinal hernia repair CAD with severe left ventricular dysfunction, DM-II, CLD Injectate given between Quadratus lumborum and psoas muscles. Indwelling catheter inserted 25 mL of 0.5% ropivacaine None Ropivacaine (0.125%) 5mL/hr via indwelling catheter Vieira et al 17 Terminal colostomy for enterovesical fistula CAD with a previous MI, chronic anemia, HTN, CKD, DM-II Injectate deposited anterolateral to the QL muscle, lateral to the transversus abdominis muscle 20 mL of 1.33% of Mepivacaine 4 mg of dexamethasone i.v and fractionated boluses of fentanyl to a total of 75 mcg i.v given No postoperative analgesia required Abbreviations : CAD, coronary artery disease; EF, ejection fraction; AV, atrioventricular; HTN, hypertension; IV, intravenous; CKD, chronic kidney disease; QL, quadratus lumborum; OSA, obstructive sleep apnea; CM, cardiomyopathy; QLB, quadratus lumborum block; COPD, chronic obstructive pulmonary disease; DM-II, diabetes type 2; CLD, chronic liver disease; MI, myocardial infarction. …”

“…14 Few studies have demonstrated the successful use of the QLB (Table 1) as a solitary anesthetic technique in abdominal surgeries. [15][16][17] However, there is a paucity of evidence regarding its use as the primary surgical anesthetic technique, especially for appendectomy.…”