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LETTERS TO EDITOR
Year : 2019  |  Volume : 13  |  Issue : 3  |  Page : 278-279

Journey of a quadratus lumborum plane catheter: Is it important to know?


1 Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra, India
2 Department of Anesthesiology, Dr. Hedgewar Hospital, Aurangabad, Maharashtra, India
3 Department of Surgery, Dr. Hedgewar Hospital, Aurangabad, Maharashtra, India
4 Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India

Correspondence Address:
Dr. Sandeep Diwan
Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra - 411 005
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.SJA_787_18

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Date of Web Publication26-Jun-2019
 


How to cite this article:
Diwan S, Kulkarni M, Kulkarni N, Nair A. Journey of a quadratus lumborum plane catheter: Is it important to know?. Saudi J Anaesth 2019;13:278-9

How to cite this URL:
Diwan S, Kulkarni M, Kulkarni N, Nair A. Journey of a quadratus lumborum plane catheter: Is it important to know?. Saudi J Anaesth [serial online] 2019 [cited 2019 Aug 20];13:278-9. Available from: http://www.saudija.org/text.asp?2019/13/3/278/260811



Sir,

We report 2 cases of patients who underwent a) left pyelolithotomy and b) right radical nephrectomy. After a standard general anethesia they received a left and a right TMQLB respectively, for perioperative analgesia. After preoperative evaluation and obtaining fitness for surgery, a standard general anesthesia with a right transmuscular quadratus lumborum block (TMQLB) for perioperative analgesia was planned. An informed consent was obtained from the patient for the same. The quadratus lumborum plane (QLP) was identified with a curvilinear ultrasound (US) probe (8–5 MHz, Sonosite Inc), as described by Børglum et al.[1] An 18-G Tuohy's needle was inserted in QLP and 20 ml of 0.2% ropivacaine was injected. The needle tip was placed at the mid part of the anterior quadratus lumborum fascia (AQLF), as visualized on the US. The distance from the skin to AQLF or the anterior thoracolumbar fascia (ATLF) was 4.5 cm on left and 4.9 cm on right. On injecting 25 ml of 0.25% bupivacaine, there was an elliptical swelling that projected anteriorly towards the peritoneum and posteriorly towards the junction of the psoas major and quadratus lumborum muscle. There was no breach of the AQ L F/ATLF and there was a predictable downward movement of psoas major muscle. Thereafter, a 20-G catheter was placed in the ATLF at 5-7 cm in both. A bolus of 5 ml of local anesthetic (LA) was injected and the spread observed again under US.

Intraoperatively we requested the surgeon to demonstrate the catheter in the QLP. As shown in [Figure 1]a, we could see the catheter coiled in the anterior thoracolumbar space and did not breach the quadratus lumborum fascia. As depicted in [Figure 1]b the catheter had perforated the ATLF.
Figure 1: (a) The catheter can be seen coiled in the anterior thoracolumbar fascia. (b) The catheter penetrated the fascia

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We feel that LA spread and the catheter placement in QLP is not always predictable. We could observe coiling and perforation of the catheter in the ATLF. The drug and the catheter takes the path of least resistance. The drug spread depends on the direction of catheter, the final position of the tip of the catheter, and the dynamics within the QLP. The dermatomes covered by the block depends on the course taken by catheter and the final spread of LA.[2],[3],[4]

Consent was taken from the patient for obtaining images for publication in medical journal without disclosing the name for academic purpose.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Børglum J, Moriggl B, Jensen K, Lönnqvist PA, Christensen AF, Sauter A, et al. Ultrasound-guided transmuscular quadratus lumborum blockade. Br J Anaesth 2013;110:3.  Back to cited text no. 1
    
2.
Carline L, McLeod GA, Lamb C. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks. Br J Anaesth 2016;117:387-94.  Back to cited text no. 2
    
3.
Dam M, Moriggl B, Hansen CK, Hoermann R, Bendtsen TF, Børglum J. The pathway of injectate spread with the transmuscular quadratus lumborum block: A cadaver study. Anesth Analg 2017;125:303-12.  Back to cited text no. 3
    
4.
Adhikary SD, El-Boghdadly K, Nasralah Z, Sarwani N, Nixon AM, Chin KJ. A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers. Anaesthesia 2017;72:73-9.  Back to cited text no. 4
    


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