Dermatomal coverage of single-injection ultrasound-guided parasagittal approach to anterior quadratus lumborum block at the lateral supra-arcuate ligament

Abstract

The subcostal quadratus lumborum (QL) block is used in postoperative analgesia for abdominal surgery. However, only a small portion of local anesthetic can spread into the thoracic paravertebral space from the injection site via the lateral arcuate ligament, due to the barrier action of the ligament. In this study, we determined the effectiveness of a new ultrasound-guided parasagittal approach to anterior QL block at the lateral supra-arcuate ligament. Twenty six patients scheduled for laparoscopic renal surgery were enrolled. The parasagittal approach to the anterior QL block at the lateral supra-arcuate ligament was carried out preoperatively. Our data showed that at 5 and 10 min after injection, the patients achieved the sensory block of dermatomes T9–T12 and T7–L1, respectively. Some patients achieved coverage as cephalad as T5 and as caudal as L3. Four patients (16.7%) developed quadriceps weakness after the blocks. The parasagittal technique provides a new choice for postoperative analgesia of abdominal surgery with rapid onset and reliable dermatomal coverage.

Trial registration: Chinese Clinical Trial Registry: ChiCTR2000029211.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Elsharkawy H, El-Boghdadly K, Barrington M. Quadratus lumborum block: anatomical concepts, mechanisms, and techniques. Anesthesiology. 2019;130:322–35.

    Article  Google Scholar 

  2. 2.

    Elsharkawy H. Quadratus lumborum block with paramedian sagittal oblique (subcostal) approach. Anaesthesia. 2016;71:241–2.

    CAS  Article  Google Scholar 

  3. 3.

    Elsharkawy H, El-Boghdadly K, Kolli S, Esa WAS, DeGrande S, Soliman LM, Drake RL. Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block: a comparative cadaveric study. Eur J Anaesthesiol. 2017;34:587–95.

    Article  Google Scholar 

  4. 4.

    Elsharkawy H, Bajracharya GR, El-Boghdadly K, Drake RL, Mariano ER. Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study. Reg Anesth Pain Med. 2019:rapm-2018–100147.

  5. 5.

    Karmakar MK, Li X, Ho AM, Kwok WH, Chui PT. Real-time ultrasound-guided paramedian epidural access: evaluation of a novel in-plane technique. Br J Anaesth. 2009;102:845–54.

    CAS  Article  Google Scholar 

  6. 6.

    Paternostro-Sluga T, Grim-Stieger M, Posch M, Schuhfried O, Vacariu G, Mittermaier C, Bittner C, Fiaka-Moser V. Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med. 2008;40:665–71.

    Article  Google Scholar 

  7. 7.

    Troyer AD, Wilson TA. Action of the diaphragm on the rib cage. J Appl Physiol. 1985;2016(121):391–400.

    Google Scholar 

  8. 8.

    Lu Y, Zhang J, Xu X, Chen W, Zhang S, Zheng H, Xia Y, Papadimos TJ, Xu XZ, Chen H. Sensory assessment and block duration of transmuscular quadratus lumborum block at L2 versus L4 in volunteers: a randomized controlled trial. Minerva Anestesiol. 2019;85:1273–80.

    Article  Google Scholar 

  9. 9.

    Elsharkawy H, Ahuja S, DeGrande S, Maheshwari K, Chan V. Subcostal approach to anterior quadratus lumborum block for pain control following open urological procedures. J Anesth. 2019;33:148–54.

    Article  Google Scholar 

  10. 10.

    Tamura T, Yokota S, Ito S, Shibata Y, Nishiwaki K. Local anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: a crossover volunteer study. J Anesth. 2019;33:26–32.

    Article  Google Scholar 

  11. 11.

    Kanemura T, Satake K, Nakashima H, Naoki S, Ouchida J, Yamaguchi H. Understanding retroperitoneal anatomy for lateral approach spine surgery. Spinal Surg Related Res. 2017;1:107–20.

    Article  Google Scholar 

  12. 12.

    Wikner M. Unexpected motor weakness following quadratus lumborum block for gynaecological laparoscopy. Anaesthesia. 2017;72:230–2.

    CAS  Article  Google Scholar 

Download references

Acknowledgments

This work was supported by the Beijing Hospitals Authority Clinical Medicne Development of Special Funding Support (XMLX202106). We thank Dr. Ryan Guffey in Department of Anesthesiology, Washington University School of Medicine, for critical reading and beneficial suggestions.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Yun Wang.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 19532 KB)

Supplementary file2 (MP4 2541 KB)

About this article

Verify currency and authenticity via CrossMark

Cite this article

Shi, R., Li, H. & Wang, Y. Dermatomal coverage of single-injection ultrasound-guided parasagittal approach to anterior quadratus lumborum block at the lateral supra-arcuate ligament. J Anesth (2021). https://doi.org/10.1007/s00540-021-02903-1

Download citation

Keywords

  • Ultrasound guidance
  • Lateral arcuate ligament
  • Quadratus lumborum block