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Quadratus lumborum block: are we aware of its side effects? A report of 2 cases

BACKGROUND AND OBJECTIVES: The quadratus lumborum block was initially described in 2007 and aims at blocking the same nerves as the ones involved on the Transverse Abdominis Plane block, while accomplishing some visceral enervation as well due to closer proximity with the neuroaxis and sympathetic t...

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Autores principales: Sá, Miguel, Cardoso, José Miguel, Reis, Hugo, Esteves, Marta, Sampaio, José, Gouveia, Isabel, Carballada, Pilar, Pinheiro, Célia, Machado, Duarte
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9391832/
https://www.ncbi.nlm.nih.gov/pubmed/28549524
http://dx.doi.org/10.1016/j.bjane.2016.09.008
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author Sá, Miguel
Cardoso, José Miguel
Reis, Hugo
Esteves, Marta
Sampaio, José
Gouveia, Isabel
Carballada, Pilar
Pinheiro, Célia
Machado, Duarte
author_facet Sá, Miguel
Cardoso, José Miguel
Reis, Hugo
Esteves, Marta
Sampaio, José
Gouveia, Isabel
Carballada, Pilar
Pinheiro, Célia
Machado, Duarte
author_sort Sá, Miguel
collection PubMed
description BACKGROUND AND OBJECTIVES: The quadratus lumborum block was initially described in 2007 and aims at blocking the same nerves as the ones involved on the Transverse Abdominis Plane block, while accomplishing some visceral enervation as well due to closer proximity with the neuroaxis and sympathetic trunk. Given its versatility, we have successfully used it in a wide range of procedures. We report two cases where we believe the dispersion of local anesthetic is likely to have led to a previously undescribed complication. CLINICAL REPORTS: We report two cases in which we performed a quadratus lumborum type II block and general anesthesia for total gastrectomy and right hemicolectomy. There were no noteworthy events while performing the block and inducing general anesthesia, but within 30–40 min serious hypotension and tachycardia were noted. As other motives for hypotension were ruled out, the event was interpreted as block-induced sympatholysis due to cephalad dispersion of the local anesthetic to the paravertebral and epidural space, and successfully managed with ephedrine and increase of the crystalloid infusion rate. CONCLUSIONS: The quadratus Lumborum block is safe to execute and provides effective abdominal wall and visceral analgesia. However, the possibility of eliciting undesired episodes should prompt caution when performing this block and practitioners should thereafter remain vigilant. Questions regarding ideal dosing, volumes, timing of block and pertinence of catheters remain to be answered.
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spelling pubmed-93918322022-08-21 Quadratus lumborum block: are we aware of its side effects? A report of 2 cases Sá, Miguel Cardoso, José Miguel Reis, Hugo Esteves, Marta Sampaio, José Gouveia, Isabel Carballada, Pilar Pinheiro, Célia Machado, Duarte Braz J Anesthesiol Clinical Information BACKGROUND AND OBJECTIVES: The quadratus lumborum block was initially described in 2007 and aims at blocking the same nerves as the ones involved on the Transverse Abdominis Plane block, while accomplishing some visceral enervation as well due to closer proximity with the neuroaxis and sympathetic trunk. Given its versatility, we have successfully used it in a wide range of procedures. We report two cases where we believe the dispersion of local anesthetic is likely to have led to a previously undescribed complication. CLINICAL REPORTS: We report two cases in which we performed a quadratus lumborum type II block and general anesthesia for total gastrectomy and right hemicolectomy. There were no noteworthy events while performing the block and inducing general anesthesia, but within 30–40 min serious hypotension and tachycardia were noted. As other motives for hypotension were ruled out, the event was interpreted as block-induced sympatholysis due to cephalad dispersion of the local anesthetic to the paravertebral and epidural space, and successfully managed with ephedrine and increase of the crystalloid infusion rate. CONCLUSIONS: The quadratus Lumborum block is safe to execute and provides effective abdominal wall and visceral analgesia. However, the possibility of eliciting undesired episodes should prompt caution when performing this block and practitioners should thereafter remain vigilant. Questions regarding ideal dosing, volumes, timing of block and pertinence of catheters remain to be answered. Elsevier 2016-10-22 /pmc/articles/PMC9391832/ /pubmed/28549524 http://dx.doi.org/10.1016/j.bjane.2016.09.008 Text en © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Information
Sá, Miguel
Cardoso, José Miguel
Reis, Hugo
Esteves, Marta
Sampaio, José
Gouveia, Isabel
Carballada, Pilar
Pinheiro, Célia
Machado, Duarte
Quadratus lumborum block: are we aware of its side effects? A report of 2 cases
title Quadratus lumborum block: are we aware of its side effects? A report of 2 cases
title_full Quadratus lumborum block: are we aware of its side effects? A report of 2 cases
title_fullStr Quadratus lumborum block: are we aware of its side effects? A report of 2 cases
title_full_unstemmed Quadratus lumborum block: are we aware of its side effects? A report of 2 cases
title_short Quadratus lumborum block: are we aware of its side effects? A report of 2 cases
title_sort quadratus lumborum block: are we aware of its side effects? a report of 2 cases
topic Clinical Information
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9391832/
https://www.ncbi.nlm.nih.gov/pubmed/28549524
http://dx.doi.org/10.1016/j.bjane.2016.09.008
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