Skip to main content

Advertisement

SpringerLink
Log in

Subcostal approach to anterior quadratus lumborum block for pain control following open urological procedures

  • Clinical Report
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

In the case of open urological surgeries, analgesic coverage at mid thoracic dermatomal levels is required. As shown in cadaveric studies, the site of QL block injection is an important determinant of the extent of dye spread and presumably local anesthetic dermatomal coverage. In this case series, we evaluated dermatomal blockade and analgesic efficacy of a subcostal approach to anterior QL block following open urological surgeries. Twenty-two adult patients undergoing renal transplant surgery (60%) and open nephrectomy (40%) received unilateral ultrasound-guided subcostal anterior QL block with catheter insertion. Sensory level, pain score (numeric rating scale, NRS), local anesthetic consumption, and opioid consumption (morphine equivalent dose, MED) were assessed daily for 3 days. The block achieved sensory blockade between T6-7 and L1-2. The most frequently affected dermatomes were T8 -T12 and the number of blocked segments was 3 (mean 2.8). The median (interquartile range Q1, Q3) of NRS pain score was 3.7 (2.8–5.5), 3.3 (2.4–4.7), 2.9 (1.9–3.6), and 2.3 (1.0–4.2) on POD0, POD1, POD2, and POD3, respectively. Our preliminary data showed that the subcostal approach to anterior QL block provides appropriate thoracic dermatome level needed for analgesia following open urological surgical procedures between T6-7 and L1-2.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Kortram K, Ijzermans JN, Dor FJ. Perioperative events and complications in minimally invasive live donor nephrectomy: a systematic review and meta-analysis. Transplantation. 2016;100:2264–75.

    Article  PubMed  Google Scholar 

  2. Alper I, Yüksel E. Comparison of acute and chronic pain after open nephrectomy versus laparoscopic nephrectomy: a prospective clinical trial. Medicine. 2016;95:e3433.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Børglum J, Moriggl B, Jensen K, Lønnqvist PA, Christensen AF, Sauter A, Bendtsen TF. Ultrasound-guided transmuscular quadratus lumborum blockade. Br J Anaesth. 2013;111:(eLetters Supplement).

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

    Article  CAS  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  7. Ohgoshi Y, Nakayama H, Kubo EN, Izawa H, Kori S, Matsukawa M. Clinical experiences of the continuous quadratus lumborum block via paramedian sagittal oblique approach. J Clin Anesth. 2017;38:89–90.

    Article  PubMed  Google Scholar 

  8. Ueshima H, Hiroshi O. Intermittent bilateral anterior sub-costal quadratus lumborum block for effective analgesia in lower abdominal surgery. J Clin Anesth. 2017;43:65.

    Article  CAS  PubMed  Google Scholar 

  9. Ueshima H, Otake H. Clinical experiences of unilateral anterior sub-costal quadratus lumborum block for a nephrectomy. J Clin Anesth. 2018;44:120.

    Article  PubMed  Google Scholar 

  10. Niraj G, Kelkar A, Jeyapalan I, Graff-Baker P, Williams O, Darbar A, Maheshwaran A, Powell R. Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery. Anaesthesia. 2011;66:465–71.

    Article  CAS  PubMed  Google Scholar 

  11. Ueshima H, Yoshiyama S, Otake H. The ultrasound-guided continuous transmuscular quadratus lumborum block is an effective analgesia for total hip arthroplasty. J Clin Anesth. 2016;31:35.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

Dr. Elsharkawy has received unrestricted educational funding from PAJUNK (GA, USA), and consultant for PACIRA (Troy Hills, NJ, USA). Those companies had no input into any aspect of the present project design or manuscript preparation.

Author information

Authors and Affiliations

  1. Department of General Anesthesiology, Pain Management and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, OH, USA

    Hesham Elsharkawy & Kamal Maheshwari

  2. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA

    Hesham Elsharkawy

  3. Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA

    Sanchit Ahuja

  4. Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Sean DeGrande

  5. Department of Anesthesia, University of Toronto, Toronto, Canada

    Vincent Chan

Authors
  1. Hesham Elsharkawy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sanchit Ahuja
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sean DeGrande
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kamal Maheshwari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vincent Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hesham Elsharkawy.

Ethics declarations

Conflict of interest

The other authors declare no conflicts of interest.

Ethical approval

Dr. Vincent Chan received honorarium from BBraun, Aspen Pharma, and SonoSite and was on the medical advisory board of Smiths Medical.

Figures’ permissions

Permission to use images was obtained from the Cleveland Clinic Department of Art Photography.

Clinical reports

This report describes human research. Cleveland Clinic Institutional Review Board (IRB 15–573) (date of approval—12 May 2015). The requirement for written informed consent was waived by the Institutional Review Board.

Additional information

Publisher’s Note

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

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 16656 KB)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elsharkawy, H., Ahuja, S., DeGrande, S. et al. Subcostal approach to anterior quadratus lumborum block for pain control following open urological procedures. J Anesth 33, 148–154 (2019). https://doi.org/10.1007/s00540-018-02605-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-018-02605-1

Keywords

Search

Navigation