Quadratus Lumborum Block Flashcards
Useful application of QL block?
abdominal surgery
ant hip surgery
what distribution do you get with QL block?
T6-L1
Why is QL better than TAP block?
get full abdominal coverage with just one block.
TAP block often requires other blocks to get full coverage
also provides visceral pain relief
how does QL block provide visceral pain relief?
from paravertebral spread
What pain relief does QL block provide?
somatic pain relief to abdominal skin, muscles, and parietal peritoneum
visceral pain relief
Which block is basically an extension of a TAP block?
QL block
What are the anterior/lateral wall muscles you need to be aware of for QL block?
rectus abdominis
external abdominal oblique
internal abdominal oblique
transversus abdominis
what are the posterior abdominal wall muscles/structures to be aware of for QL block?
erector spinae
psoas major
quadtratus lumborum
thoracolumbar fascia
what is important to understand about the QL fascia?
it is continuous with the transversus abdominus fascia
how many approaches are there for QL block?
3
which block position has highest chance of paravertebral spread?
QL 3
which block position has highest risk of peritoneal puncture?
QL 3
which block position is the most superficial?
QL2
which block position is the original?
QL1
which US probe would you use for QL block? And why?
curved transducer
because block is usually 4-8cm deep
also helps keep the long needle in view so you don’t loose it.
what dose of local for QL block?
20-40ml each side
Eddie usually uses 25ml on each side with great results
what kind of needle do you use for QL block?
21g 110mm non-stimulating
how should patient be positioned for QL block?
sitting, lateral decubitus, or supine
in what postions is the QL more thin?
sitting and supine
in what position is the QL the thickest?
lateral decubitus with hip abducted
what other structure could you accidently hit on the Right side?
the liver
what other structure could you accidently hit on the left side?
spleen
what other structures could you potentially hit?
kindeys, liver, or spleen
how could color flow help with this block?
help identify lumbar arteries that run on the post surface of the QL
what could happen when larger volumes of LA are used in the QL block?
may get better paravertebral spread, but could also get lumbar plexus > leg weakness
is there a specific billing code for QL blocks?
no, they are too new. Have to use the “other” code.
Name the block and structures
QL block
