Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy

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Abstract

The quadratus lumborum (QL) block as a postoperative analgesic method following abdominal surgery has been described by Blanco for superficial surgeries but not used for major laparotomy. This ipsilateral QL block had low pain scores and opioid use on day one with sensory block upto T8-L1. The options of various volume used and pros and cons are discussed.

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Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks.

John Laffey, J DONNELL, O Finnerty … (2011)

The extent of analgesia provided by transversus abdominis plane blocks depends upon the site of injection and pattern of spread within the plane. There are currently a number of ultrasound-guided approaches in use, including an anterior oblique-subcostal approach, a mid-axillary approach and a more recently proposed posterior approach. We wished to determine whether the site of injection of local anaesthetic into the transversus abdominis plane affects the spread of the local anaesthetic within that plane, by studying the spread of a local anaesthetic and contrast solution in four groups of volunteers. The first group underwent the classical landmark-based transversus abdominis plane block whereby two different volumes of injectate were studied: 0.3 ml.kg(-1) vs 0.6 ml.kg(-1). The second group underwent transversus abdominis plane block using the anterior subcostal approach. The third group underwent transversus abdominis plane block using the mid-axillary approach. The fourth group underwent transversus abdominis plane block using the posterior approach, in which local anaesthetic was deposited close to the antero-lateral border of the quadratus lumborum. All volunteers subsequently underwent magnetic resonance imaging at 1, 2 and 4 h following each block to determine the spread of local anaesthetic over time. The studies demonstrated that the anterior subcostal and mid-axillary ultrasound approaches resulted in a predominantly anterior spread of the contrast solution within the transversus abdominis plane and relatively little posterior spread. There was no spread to the paravertebral space with the anterior subcostal approach. The mid-axillary transversus abdominis plane block gave faint contrast enhancement in the paravertebral space at T12-L2. In contrast, the posterior approaches, using both landmark and ultrasound identifications, resulted in predominantly posterior spread of contrast around the quadratus lumborum to the paravertebral space from T5 to L1 vertebral levels. We concluded that the pattern of spread of local anaesthetic differs depending on the site of injection into the transversus abdominis plane. This may have important implications for the extent of analgesia produced with each approach. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

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Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade: description of anatomy and clinical technique.

Peter Hebbard, Michael Barrington, Carolyn Vasey (2015)

Recently, ultrasound-guided transversus abdominis plane blockade for abdominal wall analgesia has been described, and it involves injection of local anesthetic into the transversus abdominis plane. The posterior approach involves injection of local anesthetic in the lateral abdominal wall between the costal margin and the iliac crest and is suitable for postoperative analgesia after surgery below the umbilicus. The subcostal approach is suitable after abdominal surgery in the periumbilical region. The subcostal block can be modified, and the needle can be introduced along the oblique subcostal line from the xyphoid process toward the anterior part of the iliac crest. The purpose of this brief technical report was to describe in detail the anatomy and the technique of continuous oblique subcostal blockade. The goal of this approach was to produce a wider sensory blockade suitable for analgesia after surgery both superior and inferior to the umbilicus. A catheter can be placed along the oblique subcostal line in the transversus abdominis plane for continuous infusion of local anesthetic. Multimodal analgesia and intravenous opioid are used in addition because visceral pain is not blocked. Continuous oblique subcostal transversus abdominis plane block is a new technique and requires both a detailed knowledge of sonographic anatomy and technical skill for it to be successful.

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271: Tap block under ultrasound guidance: the description of a “no pops” technique

R. Blanco (2007)

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Author and article information

Journal

Journal ID (nlm-ta): J Anaesthesiol Clin Pharmacol

Journal ID (iso-abbrev): J Anaesthesiol Clin Pharmacol

Journal ID (publisher-id): JOACP

Title: Journal of Anaesthesiology, Clinical Pharmacology

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0970-9185

ISSN (Electronic): 2231-2730

Publication date (Print): Oct-Dec 2013

Volume: 29

Issue: 4

Pages: 550-552

Affiliations

[1]Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, South Australia, Australia

Author notes

Address for correspondence: Dr. Vasanth Rao Kadam, Department of Anaesthesia, TQEH, 28 Woodville Road, Woodville, South Australia 5011, Australia. E-mail: vasanth.rao@ 123456health.sa.gov.au

Article

Publisher ID: JOACP-29-550

DOI: 10.4103/0970-9185.119148

PMC ID: 3819854

PubMed ID: 24249997

SO-VID: 1291dc8d-59fe-47ad-ba54-e0e66a0b7b2a

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy

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Abstract

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Irish Journal of Paramedicine

Most cited references 5

Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks.

Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade: description of anatomy and clinical technique.

271: Tap block under ultrasound guidance: the description of a “no pops” technique

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