Local anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: a crossover volunteer study
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Previous work showed that 20 mL of local anesthetic (LA) did not spread into the paravertebral space (PVS) via the intramuscular quadratus lumborum block (QLBi). If spread of LA into the PVS can be achieved by increasing the total LA volume, QLBi can be more effective. We hypothesized that a larger volume of LA for the QLBi would spread into the PVS.
This crossover volunteer study included five healthy men. For comparison, both the ultrasound-guided QLB type 2 (QLB2) and QLBi were employed on opposite sides of each volunteer, and the spread of LA solution (0.7 mL/kg) mixed with contrast media in the PVS was assessed 1 h after the first injection using magnetic resonance imaging. Sensory loss was evaluated by pinprick 90 min post-injection. Each volunteer underwent both QLB types, and the same procedures were administered on opposite sides 7 days after the first experiment.
In total, 20 QLB blocks (10 QLB2 and 10 QLBi) were performed. LA did not spread into the PVS after the QLBi. The sensory block area included the lower abdomen after the QLB2, but not after the QLBi. The sensory block area did not extend to the upper abdominal region or the midline of the lower abdomen with either block method.
LA administered by the QLB2 spreads into the PVS of T10–T12, resulting in lower and lateral abdominal sensory loss. In contrast, LA administered by the QLBi does not spread into the PVS and results in only lateral abdominal sensory loss.
KeywordsQuadratus lumborum block Paravertebral space Volunteer study Local anesthetic spread
We thank Shusaku Baba, Atsushi Okamoto, Kenta Miyazaki, Hiroshi Usami, and Yohei Nishino for providing assistance with our nerve block maneuver. We also thank Koji Suzuki and Yusuke Kusaka for providing assistance with skiagraphy.
Compliance with ethical standards
Conflict of interest
None of the authors has any conflicts of interest to declare in relation to this work.
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