A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks
A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks
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DOI：
10.1093/bja/aew224
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发表时间：
2016-09-01
影响因子：
9.8
通讯作者：
Lamb, C.
中科院分区：
文献类型：
--
作者：
Carline, L.;McLeod, G. A.;Lamb, C.
背景资料：腹壁阻滞的后部变体包括腰方肌I型、腰方肌II型和腰方肌经肌阻滞。我们的目标是比较注射液和神经参与的传播，进行块后，使用超声引导软防腐cadvers.Methods：随机化后，有经验的麻醉师进行了三个方肌腰1，三个方肌腰2和四个transmuscular块的左侧或右侧的5具尸体。将所有尸体置于侧卧位，并使用放置在侧腹的3-9 MHz超声探头观察腰方肌。对于每个块，注入17.75ml水、2 ml胶乳和0.25ml印度油墨的20 ml混合物。72 h后解剖腰区和腹侧。两个腰方肌1和两个腰方肌2块与TAP平面内的染料扩散相关。一个腰方肌1块分散到背部深层肌肉，一个腰方肌2块分散在腹侧周围的皮下组织内。所有经肌腰方肌块一致传播到L1和L3神经根和腰大肌和腰方肌musculum.Conclusions：一致传播到腰神经根，通过腰方肌的经肌入路。
Background: Posterior variants of abdominal wall block include the quadratus lumborum type I, quadratus lumborum type II and quadratus lumborum transmuscular blocks. Our objectives were to compare the spread of injectate and nerve involvement, after conducting blocks using ultrasound guidance in soft embalmed cadavers.Methods: After randomization, an experienced anaesthetist conducted three quadratus lumborum 1, three quadratus lumborum 2 and four transmuscular blocks on the left or right sides of five cadavers. All cadavers were placed in the lateral position and the quadratus lumborum muscle seen using a 3-9 MHz ultrasound probe placed in the flank. For each block, a 20 ml mixture of 17.75 ml water, 2 mls latex and 0.25 ml India ink was injected. The lumbar region and abdominal flank were dissected 72 h later.Results: We conducted 10 blocks. Two quadratus lumborum 1 and two quadratus lumborum 2 blocks were associated with spread of dye within the TAP plane. One quadratus lumborum 1 block spread to the deep muscles of the back and one quadratus lumborum 2 block dispersed within the subcutaneous tissue surrounding the abdominal flank. All transmuscular quadratus lumborum blocks spread consistently to L1 and L3 nerve roots and within psoas major and quadratus lumborum muscles.Conclusions: Consistent spread to lumbar nerve roots was achieved using the transmuscular approach through the quadratus lumborum.