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Table of Contents
LETTER TO EDITOR
Year : 2015  |  Volume : 31  |  Issue : 1  |  Page : 130-131

Ultrasound guided quadratus lumborum block or posterior transversus abdominis plane block catheter infusion as a postoperative analgesic technique for abdominal surgery


Senior Clinical Lecturer, The University of Adelaide, The Queen Elizabeth Hospital, Woodville SA, Australia

Date of Web Publication3-Feb-2015

Correspondence Address:
Dr. Vasanth Rao Kadam
Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville SA 5011
Australia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.150575

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How to cite this article:
Kadam VR. Ultrasound guided quadratus lumborum block or posterior transversus abdominis plane block catheter infusion as a postoperative analgesic technique for abdominal surgery. J Anaesthesiol Clin Pharmacol 2015;31:130-1

How to cite this URL:
Kadam VR. Ultrasound guided quadratus lumborum block or posterior transversus abdominis plane block catheter infusion as a postoperative analgesic technique for abdominal surgery. J Anaesthesiol Clin Pharmacol [serial online] 2015 [cited 2019 Jun 18];31:130-1. Available from: http://www.joacp.org/text.asp?2015/31/1/130/150575

Sir,

Continuous catheter infusion of transversus abdominis plane (TAP) block provides as satisfactory analgesia as epidural in the postoperative period for abdominal surgery. [1],[2] Single shot ipsilateral quadratus lumborum (QL) block has been reported to provide effective analgesia for 24 h. [3] A case of continuous unilateral QL block was reported in pediatric surgery. [4] This is the first report of continuous bilateral use in an adult laparotomy.

An 89-year-old man presented for open right hemi colectomy with a midline incision. His co-morbidities were sick sinus syndrome and one recovered episode of mini stroke. His physical examination and investigations were unremarkable. A written informed consent was obtained for QL block infusion as part of multimodal analgesia. He was administered a standard uneventful general anesthesia. The peri-operative fentanyl used was 300 mcg in the operating room and 200 mcg in the recovery room. After the surgical procedure he was positioned supine with lateral tilt to administer QL block under the ultrasound (Sonosite Inc., Bothel, WA, USA) guidance. An 18 gauge Touhy's epidural needle was used to reach the junction of TAP and QL muscle.Normal saline 5 mL was used to identify that plane. A volume of 20 ml of 0.5% of Ropivacaine (Naropin-Astra Zeneca Sydney, NSW, Australia) bolus was injected in that plane just over QL [Figure 1]. This was followed by epidural catheter insertion to facilitate continuous infusion [Figure 2]. A similar technique was performed on the other side. A continuous infusion of 0.2% Ropivacaine at 5 ml/h was delivered by 'On Q pain relief system' pain buster pump (Kimberly Clark CA USA). On the pain scale of 0-10, the 1 st h dynamic pain scores were 6 on arrival and reduced to 2 after 1 hr stay in recovery. The day 1 and day 2 dynamic pain scores were between 1 and 2. He was administered paracetamol- 1 g qid and tramadol- 100 mg tid. The only rescue medication used for 48 h was 10 mg of oxycodone. This QL block infusion has the advantage of covering pain arising from long incisions such as supra and infra umbilical regions without requiring multiple catheters. This could be due to spread of LA from QL and Psoas muscles to the paravertebral space covering more segments possibly from T4 to L2. Many case series or trials need to be conducted before confirming its efficacy.
Figure 1: Ultra sound image of the QL block with LA. EO = external oblique, IO = internal oblique, QL = Quadratus lumborum

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Figure 2: Lateral tilt position QL block with secured catheter

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In conclusion, ultrasound guided QL catheter infusion had low pain scores with minimal use of opioid analgesia without any complication.


  Acknowledgment Top


I appreciate Martin Tyson for assisting in images. Dr T. Venkatesan for going through the manuscript.

 
  References Top

1.
Rao Kadam V, Van Wijk RM, Moran JI, Miller D. Epidural versus continuous transversus abdominis plane catheter technique for postoperative analgesia after abdominal surgery. Anaesth Intensive Care 2013;41:476-81.  Back to cited text no. 1
[PUBMED]    
2.
Niraj G, Kelkar A, Jeyapalan I, Graff-Baker P, Williams O, Darbar A, et al. Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery. Anaesthesia 2011;66:465-71.  Back to cited text no. 2
    
3.
Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol 2013;29:550-2.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Visoiu M, Yakovleva N. Continuous postoperative analgesia via quadratus lumborum block - An alternative to transversus abdominis plane block. Paediatr Anaesth 2013;23:959-61.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]


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