[The supine coronal midaxillary approach to anterior quadratus lumborum block: case report].
Abordagem supina axilar média coronal para realização de bloqueio do quadrado lombar anterior: relato de casos.
Anestesia regional
Dor pós‐operatória
Postoperative pain
Quadrado lombar
Quadratus lumborum
Regional anesthesia
Ultrasound
Ultrassom
Journal
Brazilian journal of anesthesiology (Elsevier)
ISSN: 2352-2291
Titre abrégé: Braz J Anesthesiol
Pays: Brazil
ID NLM: 101624623
Informations de publication
Date de publication:
Historique:
received:
26
12
2019
revised:
13
04
2020
accepted:
17
04
2020
pubmed:
3
8
2020
medline:
23
7
2021
entrez:
3
8
2020
Statut:
ppublish
Résumé
There are various approaches to perform an ultrasound guided Quadratus Lumborum Block (QLB). The lateral, posterior, anterior or trans muscular and subcostal paramedian are the various approaches described for performing a QLB. Each of these blocks are aimed to achieve a maximum spread with high volume and low concentration of local anesthetics. In this novel approach a curvilinear ultrasound probe was used with the patient lying in supine position. The probe was placed longitudinally in the mid axillary line to visualize Quadratus Lumborum Muscle (QLM) in the coronal plane. The needle was then introduced from cranial to caudal direction and catheters were inserted in the Anterior Thoracolumbar Fascia (ATLF) up to a distance of 4-5 cm in 24 patients for an anterior approach to acetabulum fractures. The needle tip and the Local Anesthetic (LA) spread was visible in all patients. All patients except 4 had excellent perioperative pain relief considering stable hemodynamics and VAS 2-3/10 for the first 48 hours. All patients received 1g intravenous paracetamol each 8hours. VAS in postoperative period was 2-3/10, in 20/24 patients. In the postoperative period, 4 patients complained of persistent pain, requiring intravenous fentanyl boluses and multimodal analgesia. Mean VAS score was 2.87 from 0-12 hours, 3.14 from 12-24 hours, and 3.35 from 24-48 hours. There were no block-related complications in any patient. The supine midaxillary coronal approach to anterior QLB is an effective and feasible approach to QLB which can be performed in supine position.
Sections du résumé
BACKGROUND
BACKGROUND
There are various approaches to perform an ultrasound guided Quadratus Lumborum Block (QLB). The lateral, posterior, anterior or trans muscular and subcostal paramedian are the various approaches described for performing a QLB. Each of these blocks are aimed to achieve a maximum spread with high volume and low concentration of local anesthetics.
CASE REPORT
METHODS
In this novel approach a curvilinear ultrasound probe was used with the patient lying in supine position. The probe was placed longitudinally in the mid axillary line to visualize Quadratus Lumborum Muscle (QLM) in the coronal plane. The needle was then introduced from cranial to caudal direction and catheters were inserted in the Anterior Thoracolumbar Fascia (ATLF) up to a distance of 4-5 cm in 24 patients for an anterior approach to acetabulum fractures. The needle tip and the Local Anesthetic (LA) spread was visible in all patients. All patients except 4 had excellent perioperative pain relief considering stable hemodynamics and VAS 2-3/10 for the first 48 hours. All patients received 1g intravenous paracetamol each 8hours. VAS in postoperative period was 2-3/10, in 20/24 patients. In the postoperative period, 4 patients complained of persistent pain, requiring intravenous fentanyl boluses and multimodal analgesia. Mean VAS score was 2.87 from 0-12 hours, 3.14 from 12-24 hours, and 3.35 from 24-48 hours. There were no block-related complications in any patient.
CONCLUSION
CONCLUSIONS
The supine midaxillary coronal approach to anterior QLB is an effective and feasible approach to QLB which can be performed in supine position.
Identifiants
pubmed: 32739200
pii: S0034-7094(20)30354-8
doi: 10.1016/j.bjan.2020.04.007
pmc: PMC9373086
pii:
doi:
Substances chimiques
Anesthetics, Local
0
Acetaminophen
362O9ITL9D
Types de publication
Case Reports
Langues
por
Sous-ensembles de citation
IM
Pagination
443-447Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.
Références
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pubmed: 29135590
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pubmed: 30659364
Saudi J Anaesth. 2019 Jul-Sep;13(3):278-279
pubmed: 31333391