Ultrasound guided quadratus lumborum block for congenital diaphragmatic hernia repair : A case report

Abstract

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.