Ultrasound-guided continuous transmuscular quadratus lumborum block- L4 or L2 level catheter insertion for analgesia in open abdominal surgery: Case series

Kadam, Vasanth Rao; Howell, Stuart

doi:10.4103/ija.ija_242_18

Cited by 12 publications

(20 citation statements)

References 14 publications

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“…A randomized trial is underway in our institution exploring its use during open major abdominal surgery. Till now, there has been only a single case series comparing the needle position at the anterior aspect of the QL muscle, between the L2 and L4 level approach 6 . Anecdotally we have not observed lower limb weakness, but this was not formally studied.…”

Section: Discussionmentioning

confidence: 99%

“…We found no other adverse events at the L2 level. However, data is limited on the differences between these approaches 6 . Further studies should investigate the role of TQL in open upper gastrointestinal and colorectal surgeries using TQL at L2 level (higher) and for pelvic surgery at lower (L3-L4) level.…”

Section: Discussionmentioning

confidence: 99%

“…3 After encountering side-effects such as leg paresis with Børglum et al's L4 approach, we attempted TQL block at a higher level (L2 transverse process) with patients in the lateral position, using a transverse posterolateral (TPL) approach, in abdominal surgery. [4][5][6] In this brief communication, we elaborate on these two approaches of TQL block at the L2 level, in terms of the anatomy, sonoanatomy and technical aspects.…”

Section: Introductionmentioning

confidence: 99%

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

Kadam

Wijk

Ludbrook

et al. 2019

Anaesth Intensive Care

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Kadam

Wijk

Ludbrook

et al. 2019

Anaesth Intensive Care

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“…Many fascial blocks have been used for post-operative analgesia in lower abdominal surgery – caudal block, transversus abdominis plane (TAP) block and Quadratus lumborum block (QLB) to name some. [ 2 3 4 5 6 ] A new block in the armamentarium is ultrasound-guided erector spinae plane (US-ESP) block described by Forero et al . in 2016.…”

Section: Introductionmentioning

confidence: 99%

The analgesic effect of bilateral ultrasound-guided erector spinae plane block in paediatric lower abdominal surgeries: A randomised, prospective trial

2020

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Background and Aims: This study aims to evaluate the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) in paediatric lower abdominal surgeries. Methods: Randomised, prospective trial. Forty patients, aged 2–10 years with the American Society of Anesthesiologists Score of I and II scheduled for elective lower abdominal surgery were included in the study. Interventions: Patients were randomised into two groups as control group and ESPB group. Ultrasound-guided erector spinae plane block at L1 vertebral level was performed preoperatively using 0.5 ml/kg 0.25% bupivacaine (max 20 ml) for the patients in ESPB group. Analgesic requirements and time to first analgesic requirement were recorded and Face, Legs, Activity, Cry and Consolability (FLACC) scores for pain were recorded at 0, 1, 2, 3, 6, 12 and 24 h postoperatively. Results: Forty patients were included in the final analyses. Significant difference was determined between the groups on post-operative morphine requirement and FLACC scores at 3 h and 6 h postoperatively ( P < 0.05). Significant difference was also determined in time to first dose of rescue analgesia between the groups ( P < 0.05). Conclusions: This study shows that the ESPB provides adequate post-operative analgesia in paediatric patients undergoing lower abdominal surgery.

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“…No intrathecal block, local anesthetic toxicity, or weakened lower right limb muscle strength were observed before anesthesia induction and during postoperative follow-up. The block range of QL block can be affected by various factors, such as puncture level, block approach, and drug volume[16][17][18]. Thus, different block planes and approaches can be selected according to the needs for analgesia.…”

mentioning

confidence: 99%

Ultrasound Guided Continuous Quadratus Lumborum Block Hastened Recovery in Patients Undergoing Open Liver Resection: A Randomized Controlled, Open-label Trial

Zhu

Yang

et al. 2019

Preprint

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Background Quadratus lumborum (QL) block is increasingly being used as a new abdominal nerve block technique. In some studies of mid and lower abdominal and hip analgesia, continuous QL block achieved favorable outcomes as an alternative to continuous intravenous analgesia with opioids. However, the use of continuous QL block for upper abdominal pain is less well characterized. This study aimed to investigate the effects of continuous anterior QL block (CQLB) on postoperative pain and recovery in patients undergoing open liver resection. Methods Sixty-three patients underwent elective open liver resection were randomly divided into continuous anterior QL block (CQLB, n = 32) group and patient-controlled intravenous analgesia (PCIA, n = 31) group. Patients in CQLB group underwent ultrasound-guided anterior QL block at the second lumbar vertebral transverse processes before general anesthesia, followed by postoperative CQLB analgesia. Patients in PCIA group underwent continuous intravenous analgesia postoperatively. Postoperative numerical rating scale (NRS) pain scores upon coughing and at rest, self-administered analgesic counts, rate of rescue analgesic use, time to first out-of-bed activity and anal flatus after surgery, and incidences of analgesic-related adverse effects were recorded. Results Postoperative NRS pain scores on coughing in CQLB group at different time points and NRS pain score at rest 48 h after surgery were significantly lower than those in PCIA group (P <0.05). Time to first out-of-bed activity and anal flatus after surgery in CQLB group were significantly earlier than those in PCIA group (P <0.05). No significant differences of postoperative self-administered analgesic counts, rate of postoperative rescue analgesic usage, or incidences of analgesic-related adverse effects were found between the two groups (P >0.05). Conclusions Ultrasound-guided anterior QL block significantly alleviated the pain during coughing after surgery, shortened the time to first out-of-bed activity and anal flatus, promoting postoperative recovery of the patients undergoing open liver resection.

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Ultrasound-guided continuous transmuscular quadratus lumborum block- L4 or L2 level catheter insertion for analgesia in open abdominal surgery: Case series

Cited by 12 publications

References 14 publications

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

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

The analgesic effect of bilateral ultrasound-guided erector spinae plane block in paediatric lower abdominal surgeries: A randomised, prospective trial

Ultrasound Guided Continuous Quadratus Lumborum Block Hastened Recovery in Patients Undergoing Open Liver Resection: A Randomized Controlled, Open-label Trial

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