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A novel ultrasound-guided lateral quadratus lumborum block in dogs: a comparative cadaveric study of two approaches

Published:August 13, 2020DOI:https://doi.org/10.1016/j.vaa.2020.08.003

      Abstract

      Objective

      To describe an ultrasound-guided lateral quadratus lumborum (LQL) block technique and the spread characteristics of lidocaine–dye injected in the LQL plane using a transversal (LQL-T) or a longitudinal (LQL-L) approach.

      Study design

      Experimental anatomic study.

      Animals

      A total of eight canine cadavers.

      Methods

      Bilateral ultrasound-guided injections in the fascial plane lateral to the quadratus lumborum muscle and medial to the thoracolumbar fascia (LQL plane) with the needle directed at the first lumbar (L1) transverse process were performed using lidocaine–dye (0.3 mL kg−1). Anatomical dissection determined the dye distribution, sympathetic trunk staining and number of spinal nerves stained circumferentially >1 cm.

      Results

      The LQL fascial plane was ultrasonographically recognized in all cadavers and filled with lidocaine–dye in all eight cadavers with the LQL-T approach and in six with LQL-L. The injectate spread ventral to the lumbar transverse processes, around the quadratus lumborum muscle and dorsal to the transversalis fascia, affecting the ventral branches of the spinal nerves and the sympathetic trunk. A median (range) of 4 (3–5) and 3 (0–4) ventral branches of the thoracolumbar nerves were dyed with LQL-T and LQL-L approaches, respectively (p = 0.04). The most cranial nerve stained was the twelfth thoracic (T12) with the LQL-T approach and T13 with LQL-L, and the most caudal was L3 with both approaches. The incidence of sympathetic trunk staining was significantly higher using LQL-T (six injections) compared with LQL-L (one injection; p = 0.04). Dye was not observed in the lumbar plexus, epidural space or abdominal cavity.

      Conclusions and clinical relevance

      Ultrasound-guided LQL-T approach resulted in a more consistent spread toward the spinal nerves and sympathetic trunk compared with LQL-L approach. Further studies are necessary to assess the LQL block effectiveness and success rate in live dogs.

      Keywords

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      References

        • Argus A.P.V.
        • Freitag F.A.V.
        • Bassetto J.E.
        • Vilani R.G.
        Quadratus lumbar block for intraoperative and postoperative analgesia in a cat.
        Vet Anaesth Analg. 2020; 47: 415-417
        • Akerman M.
        • Pejčić N.
        • Veličković I.
        A review of the quadratus lumborum block and ERAS.
        Front Med (Lausanne). 2018; 5: 44
        • Børglum J.
        • Moriggl B.
        • Jensen K.
        • et al.
        Ultrasound-guided transmuscular quadratus lumborum blockade.
        Br J Anaesth. 2013; 111https://doi.org/10.1093/bja/el_9919
        • Castañeda-Herrera F.E.
        • Buriticá-Gaviria E.F.
        • Echeverry-Bonilla D.F.
        Anatomical evaluation of the thoracolumbar nerves related to the transversus abdominis plane block technique in the dog.
        Anat Histol Embryol. 2017; 46: 373-377
        • Chin K.J.
        • McDonnell J.G.
        • Carvalho B.
        • et al.
        Essentials of our current understanding: abdominal wall blocks.
        Reg Anesth Pain Med. 2017; 42: 133-183
        • Dam M.
        • Moriggl B.
        • Hansen C.K.
        • et al.
        The pathway of injectate spread with the transmuscular quadratus lumborum block: a cadaver study.
        Anesth Analg. 2017; 125: 303-312
        • Elsharkawy H.
        • Pawa A.
        • Mariano E.R.
        Interfascial plane blocks: back to basics.
        Reg Anesth Pain Med. 2018; 43: 341-346
        • Elsharkawy H.
        • El-Boghdadly K.
        • Barrington M.
        Quadratus lumborum block: anatomical concepts, mechanisms, and techniques.
        Anesthesiology. 2019; 130: 322-335
        • Evans H.E.
        • de Lahunta A.
        The autonomic nervous system.
        in: Evans H.E. de Lahunta A. Miller’s Anatomy of the Dog. 4th edn. Elsevier, USA2013: 575-588
        • Garbin M.
        • Portela D.A.
        • Bertolizio G.
        • et al.
        Description of ultrasound-guided quadratus lumborum block technique and evaluation of injectate spread in canine cadavers.
        Vet Anaesth Analg. 2020; 47: 249-258
        • Hartnack A.
        • Lepiz M.
        • Voges A.
        • et al.
        Establishing the quadratus lumborum block in goats.
        Vet Anaesth Analg. 2019; 46 (abstract): 833
        • İpek C.B.
        • Kara D.
        • Yılmaz S.
        • et al.
        Comparison of ultrasound-guided transversus abdominis plane block, quadratus lumborum block, and caudal epidural block for perioperative analgesia in pediatric lower abdominal surgery.
        Turk J Med Sci. 2019; 49: 1395-1402
        • Kang W.
        • Lu D.
        • Yang X.
        • et al.
        Postoperative analgesic effects of various quadratus lumborum block approaches following cesarean section: a randomized controlled trial.
        J Pain Res. 2019; 12: 2305-2312
        • Kim S.H.
        • Kim N.
        • Lee B.
        • et al.
        Effectiveness of quadratus lumborum block for postoperative pain: a systematic review and meta-analysis.
        Minerva Anesthesiol. 2020; 86: 554-564
        • Kumar A.
        • Sadeghi N.
        • Wahal C.
        • et al.
        Quadratus lumborum spares paravertebral space in fresh cadaver injection.
        Anesth Analg. 2017; 125: 708-709
        • Liu X.
        • Song T.
        • Chen X.
        • et al.
        Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries: a systematic review and meta-analysis of randomized controlled trials.
        BMC Anesthesiol. 2020; 20: 53
        • Machi A.
        • Joshi G.P.
        Interfascial plane blocks.
        Best Pract Res Clin Anaesthesiol. 2019; 33: 303-315
        • Otero P.E.
        • Fuensalida S.E.
        • Russo P.C.
        • et al.
        Mechanism of action of the erector spinae plane block: distribution of dye in a porcine model.
        Reg Anesth Pain Med. 2020; 45: 198-203
        • Portela D.A.
        • Campoy L.
        • Otero P.E.
        • et al.
        Ultrasound-guided thoracic paravertebral injection in dogs: a cadaveric study.
        Vet Anaesth Analg. 2017; 44: 636-645
        • Portela D.A.
        • Castro D.
        • Romano M.
        • et al.
        Ultrasound-guided erector spinae plane block in canine cadavers: relevant anatomy and injectate distribution.
        Vet Anaesth Analg. 2019; 47: 229-237
        • Sa M.
        • Cardoso J.M.
        • Reis H.
        • et al.
        [Quadratus lumborum block: are we aware of its side effects? A report of 2 cases].
        Rev Bras Anestesiol. 2018; 68: 396-399
        • Tamura T.
        • Yokota S.
        • Ito S.
        • et al.
        Local anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: a crossover volunteer study.
        J Anesth. 2019; 33: 26-32
        • Ueshima H.
        • Hiroshi O.
        Incidence of lower-extremity muscle weakness after quadratus lumborum block.
        J Clin Anesth. 2018; 44: 104
        • Ueshima H.
        • Otake H.
        • Lin J.A.
        Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques.
        Biomed Res Int. 2017; 2017: 2752876
        • Verma V.
        • Sheikh Z.
        • Ahmed A.S.
        Nociception and role of immune system in pain.
        Acta Neurol Belg. 2015; 115: 213-220
        • Visoiu M.
        • Pan S.
        Quadratus lumborum blocks: two cases of associated hematoma.
        Paediatr Anaesth. 2019; 29: 286-288
        • Wikner M.
        Unexpected motor weakness following quadratus lumborum block for gynaecological laparoscopy.
        Anaesthesia. 2017; 72: 230-232