Unexpected motor weakness following quadratus lumborum block for gynaecological laparoscopy

Abstract

SummaryQuadratus lumborum block has recently been described as an effective and long-lasting analgesic strategy for various abdominal operations, including gynaecological laparoscopy. Despite evidence that the analgesic effect is mediated by indirect paravertebral block and that local anaesthetic spreads to the lumbar paravertebral space, there have been no reports to date of lower limb motor weakness. We present a patient with unilateral hip flexion and knee extension weakness leading to unplanned overnight admission following lateral quadratus lumborum block with 20 ml levobupivacaine 0.25%. The L2 dermatomal sensory loss and hip flexion weakness suggested spread to either the L2 paravertebral space or to the lumbar plexus, causing weakness of the psoas and iliacus muscles and possibly the quadriceps. The duration of motor block was approximately 18 h. This complication should be considered when performing the block, especially in the setting of day-case surgery.

Analgesic effect of the ultrasound-guided subcostal approach to transmuscular quadratus lumborum block in patients undergoing laparoscopic nephrectomy: a randomized controlled trial

“…In the current study, the incidence of PONV was lower in the QLB group than in the C group, and it may be associated with less consumption of opioids. Consistent with the case reported by Wikner et al [25] and Hockett et al, [26] one patient in the QLB group presented with femoral nerve block partly due to the spread of LA to the lumbar paravertebral space and blockade at part of the lumbar plexus.…”

Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial

“…A case report and a study presented in the literature, reported weakness in the lower extremity on the block administration side [22,31]. In the study by Okmen et al [22], it was found that pneumoperitoneum established during laparoscopic cholecystectomy might cause this weakness by increasing the drug spread.…”

Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Children Undergoing Low Abdominal Surgery

“…However, this seems to be the only reported complication in literature. 24 Blanco et al 11 reported that no complications were encountered in patients who had a cesarean delivery, particularly because the QL2 block is a superficial and safe block.…”