Ultrasound guided quadratus lumborum block for congenital diaphragmatic hernia repair : A case report
Perioperative use of ultrasound for various nerve blocks has gained popularity and is being widely used with precision for analgesia throughout the perioperative period. Quadratus lumborum block is a novel block that has been successfully used for various upper as-well-as lower abdominal surgeries as an anesthetic and analgesic technique as a single shot or a continuous infusion technique inserting a catheter. This analgesic technique has been described sparsely in the literature especially for neonates. We report a case of two days old child who was diagnosed as a left-sided congenital diaphragmatic hernia and was planned for surgical repair of the hernia. Ultrasound-guided quadratus lumborum block was planned for analgesic technique in this neonate to reduce opioid requirements and related complications. In the operating room, after induction of anesthesia and endotracheal intubation, the neonate was placed on lateral position. Using a high-frequency linear probe, scanning was done from anterior abdominal wall identifying the abdominal muscles namely external oblique, internal oblique, transversus abdominis from above below. On further scanning posteriorly the visualization of quadratus lumborum, psoas major, transverse process and latissimus dorsi muscle, which was the endpoint of scanning and deposition of local anesthetics. Bupivacaine 0.5% 1.8ml was injected between the planes of psoas major and quadratus lumborum muscle. This resulted in low dose opioid requirement in the postoperative period and satisfactory pain scores. This opioid sparing analgesic technique as ultrasound-guided quadratus lumborum block can be used for congenital diaphragmatic hernia repair for postoperative pain management and possible early extubation and reduction of post-op pulmonary complications.
- Blanco R, Ansari T, Girgis E. Quadratuslumborum block for postoperative pain after caesarean section: A randomized controlled trial.Eur J Anaesthesiol. 2015;32:812-8.https://doi.org/10.1097/EJA.0000000000000299 PMid:26225500
- Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J AnaesthesiolClinPharmacol. 2013;29:550-2.https://doi.org/10.4103/0970-9185.119148 PMid:24249997 PMCid:PMC3819854
- Kadam VR, Howell S. Ultrasound-guided continuous transmuscular quadratus lumborum block - L4 or L2 level catheter insertion for analgesia in open abdominal surgery: Case series. Indian Journal of Anaesthesia; 2018;62(7):555-7.https://doi.org/10.4103/ija.IJA_242_18 PMid:30078860 PMCid:PMC6053896
- Krohg A, Ullensvang K, Rosseland LA, et al. The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: a randomized clinical trial. AnesthAnalg. 2018;126(2): 559-65.https://doi.org/10.1213/ANE.0000000000002648 PMid:29135590
- Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. Biomed Res Int. 2017; 2017:2752876.https://doi.org/10.1155/2017/2752876PMid:28154824 PMCid:PMC5244003
- Shafeek AM, Gomaa GA. AbdElmalek FA. A Comparative Study between Ultrasound Guided Quadratus Lumborum Block versus Ultrasound Guided Transversus Abdominis Plane Block in Laporoscopic Bariatric Surgery. Egypt J Hosp Med. 2018; 70(12): 2090-9.https://doi.org/10.12816/0045035
- Chakraborty A, Goswami J, Patro V. Ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient. A A Case Rep. 2015; 4:34-6.https://doi.org/10.1213/XAA.0000000000000090 PMid:25642956
- Baidya DK, Maitra S, Arora MK, et al. Quadratuslumborum block: an effective method of perioperative analgesia in children undergoing pyeloplasty. J ClinAnesth. 2015;27:694-6.https://doi.org/10.1016/j.jclinane.2015.05.006 PMid:26174113
- Liu Y, Barlow M, Lipskar A, Barnett N, Hagen J, Kars M. Ultrasound Guided Quadratus Lumborum Block for an Opioid- Free CDH Repair. Poster presented at:ASRA 2018 World Congress on Regional Anesthesia & Pain Medicine; 2018 Apr 19-21; New York City, NY.
- Bhattarai PR, Rayamajhi AJ, Yadav RK, Paudel SC, Pangeni A, Byanjankar B, Pandit R. Comparison of ultrasound-guided nerve blocks and subarachnoid block as an anaesthetic technique for appendectomy: a retrospective study . Journal of Society of Anesthesiologist of Nepal (JSAN) 2017;4(1):16-22.https://doi.org/10.3126/jsan.v4i1.17384
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