Mod IV: Quadratus Lumborum

Question 1

Quadratus Lumborum Block

_{Useful applications:}

Answer 1

›Abdominal Surgery

›Ex Lap - Whipple - Liver resection

›Gastrectomy - Abdominal hysterectomy - ›Nephrectomy

›Anterior Hip

Question 2

_{Quadratus Lumborum Block}

›Block Distribution - Analgesia:

Answer 2

T6-L1​

Question 3

_{Quadratus Lumborum Block}

›Block Distribution - ›Somatic pain relief:

Answer 3

To abdominal skin, muscles, parietal peritoneum

Question 4

_{Quadratus Lumborum Block}

›Block Distribution - ›Possible Visceral pain relief:

Answer 4

Due to paravertebral spread

›Better than TAP block

Question 5

_{Quadratus Lumborum Block}

Anatomy:

Answer 5

Quadratus Lumborum Block

Question 6

_{Quadratus Lumborum Anatomy}

›Anterior/lateral abdominal wall muscles:

Answer 6

Rectus Abdominis

›External Oblique

›Internal Oblique

›Transversus Abdominis

Question 7

_{Quadratus Lumborum Anatomy}

›Posterior abdominal wall:

Answer 7

Erector spinae

›Psoas major

›Quadratus lumborum

›Thoracolumbar fascia

Question 8

_{Quadratus Lumborum Block}

Needle placement:

Answer 8

Needle placement

Question 9

_{Quadratus Lumborum Block}

›Equipment:

Answer 9

›Curved transducer

›Echogenic Block needle

^{›PAJUNK 21ga x 110mm non-stimulating}

›Local

^{›20-40 ml per side}

›Skin prep

›Lidocaine – skin anesthesia

Question 10

_{Quadratus Lumborum Block}

Positioning:

Answer 10

›Sitting

›QL has thinner appearance

›Can do R/L blocks without repositioning

›

Lateral decubitus

›QL has thicker appearance when hip abducted making it easier to identify

›May be ergonomically better

Question 11

_{Quadratus Lumborum Block}

Ultrasound view

Answer 11

Ultrasound view

Question 12

_{Quadratus Lumborum Block}

Clinical pearls:

Answer 12

›Needle cautiously when kidney, liver, or spleen in your US view

›Using color flow may be helpful in identifying lumbar arteries that run on posterior surface of QL

›Larger volumes of LA may give you better paravertebral spread

›CPT code 64450 “other”