Cadaveric Evaluation of Different Approaches for Quadratus Lumborum Blocks
Cadaveric Evaluation of Different Approaches for Quadratus Lumborum Blocks
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DOI：
10.1155/2018/2368930
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发表时间：
2018-01-01
影响因子：
2.9
通讯作者：
Kim, Shin Hyung
中科院分区：
文献类型：
--
作者：
Yang, Hun-Mu;Park, Sang Jun;Kim, Shin Hyung
背景。腰方肌阻滞（QL）是一种主要对腹壁提供镇痛和麻醉的腹部截断阻滞技术。这项尸体研究是为了比较超声引导QL块在软防腐尸体中不同针头方法之间的染料扩散。方法。随机化后，一名经验丰富的麻醉师对5具尸体进行了2次侧位阻滞，3次后位阻滞和5次可选的左侧或右侧QL阻滞。替代入路的靶注射点为腰椎筋膜间三角，与常规后路QL阻滞相同，但针迹不同。每块注射20ml染料溶液。腰椎及腹侧解剖。结果。成功执行了10个区块。无论采用何种入路，在所有阻滞中，中胸腰筋膜染色深，但前层染色较少。另一种入路与注入物向腹横肌和腹横肌筋膜平面扩散有关。尽管针头放置准确，但所有侧位QL阻滞均与一定量的肌内或皮下浸润有关。两个后QL块显示深染色后胸腰筋膜，其中一个与明显的皮下染色相关。肋下神经、髂腹下神经和髂腹股沟神经主要受累，但胸椎旁间隙和腰丛神经未受影响。结论。与传统方法相比，QL块的替代方法能够达到相当的程度。
Background. A quadratus lumborum (QL) block is an abdominal truncal block technique that primarily provides analgesia and anaesthesia to the abdominal wall. This cadaveric study was undertaken to compare the dye spread between different needle approaches for ultrasound-guided QL blocks in soft-embalmed cadavers. Methods. After randomization, an experienced anesthesiologist performed two lateral, three posterior, and five alternative QL blocks on the left or right sides of five cadavers. The target injection point for the alternative approach was the lumbar interfascial triangle, same as that of conventional posterior QL block, with a different needle trajectory. For each block, 20 ml of dye solution was injected. The lumbar region and abdominal flank were dissected. Results. Ten blocks were successfully performed. Regardless of the approach used, the middle thoracolumbar fascia was deeply stained in all blocks, but the anterior layer was less stained. The alternative approach was more associated with spread of injectate to the transversus abdominis and transversalis fascia plane. Despite accurate needle placement, all lateral QL blocks were associated with a certain amount of intramuscular or subcutaneous infiltration. Two posterior QL blocks showed a deeply stained posterior thoracolumbar fascia, and one of them was associated with obvious subcutaneous staining. The subcostal, iliohypogastric, and ilioinguinal nerves were mostly involved, but the thoracic paravertebral space and lumbar plexus were not affected in all blocks. Conclusions. The alternative approach for QL blocks was able to achieve a comparable extent when compared to the conventional approach.