Abordagem supina axilar média coronal para realização de bloqueio do quadrado lombar anterior: relato de casos

Sandeep Diwan , Rafael Blanco , Medha Kulkarni , Atul Patil , Abhijit Nair
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引用次数: 2

Abstract

Background

There are various approaches to perform an ultrasound guided Quadratus Lumborum Block (QLB). The lateral, posterior, anterior or trans muscular and subcostal paramedian are the various approaches described for performing a QLB. Each of these blocks are aimed to achieve a maximum spread with high volume and low concentration of local anesthetics.

Case report

In this novel approach a curvilinear ultrasound probe was used with the patient lying in supine position. The probe was placed longitudinally in the mid axillary line to visualize Quadratus Lumborum Muscle (QLM) in the coronal plane. The needle was then introduced from cranial to caudal direction and catheters were inserted in the Anterior Thoracolumbar Fascia (ATLF) up to a distance of 4−5 cm in 24 patients for an anterior approach to acetabulum fractures. The needle tip and the Local Anesthetic (LA) spread was visible in all patients. All patients except 4 had excellent perioperative pain relief considering stable hemodynamics and VAS 2−3/10 for the first 48 hours. All patients received 1 g intravenous paracetamol each 8 hours. VAS in postoperative period was 2−3/10, in 20/24 patients. In the postoperative period, 4 patients complained of persistent pain, requiring intravenous fentanyl boluses and multimodal analgesia. Mean VAS score was 2.87 from 0−12 hours, 3.14 from 12−24 hours, and 3.35 from 24−48 hours. There were no block‐related complications in any patient.

Conclusion

The supine midaxillary coronal approach to anterior QLB is an effective and feasible approach to QLB which can be performed in supine position.

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冠状中腋窝仰卧入路阻滞腰椎前方:病例报告
超声引导腰方肌阻滞(QLB)有多种方法。侧入路、后入路、前入路或经肌肉和肋下旁入路是进行QLB的各种入路。每一个区块都旨在通过高剂量和低浓度的局部麻醉剂实现最大的传播。病例报告:在这种新方法中,患者仰卧位使用曲线超声探头。探头纵向放置于腋窝中线,在冠状面显示腰方肌(QLM)。24例患者采用髋臼骨折前路入路,针从颅向尾向插入,导管插入前胸腰筋膜(ATLF) 4 - 5 cm。所有患者均可见针尖和局麻药(LA)扩散。考虑到前48小时血流动力学稳定和VAS 2−3/10,除4例患者外,所有患者围手术期疼痛缓解良好。所有患者每8小时静脉注射1 g扑热息痛。术后VAS评分为2−3/10,其中20/24例。术后4例患者主诉持续疼痛,需静脉注射芬太尼丸及多模式镇痛。平均VAS评分为0 ~ 12小时2.87分,12 ~ 24小时3.14分,24 ~ 48小时3.35分。所有患者均无阻滞相关并发症。结论仰卧位腋中冠状入路是一种有效可行的QLB前路入路,可在仰卧位下行。
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来源期刊
CiteScore
1.50
自引率
0.00%
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0
审稿时长
21 weeks
期刊介绍: The Brazilian Journal of Anesthesiology is the official journal of the Brazilian Anesthesiology Society. It publishes articles classified into the following categories: -Scientific articles (clinical or experimental trials)- Clinical information (case reports)- Reviews- Letters to the Editor- Editorials. The journal focuses primarily on clinical trials, with scope on clinical practice, aiming at providing applied tools to the anesthesiologist and critical care physician. The Brazilian Journal of Anesthesiology accepts articles exclusively forwarded to it. Articles already published in other journals are not accepted. All articles proposed for publication are previously submitted to the analysis of two or more members of the Editorial Board or other specialized consultants.
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