Experimental substantiation of the volume of a local anesthetic during quadratus lumborum block

B.V. Zaletskyi, D.V. Dmytriiev, V.I. Pivtorak, A.V. Dusik, O.O. Kalinchuk, V.S. Konoplitskyi


Background. Quadratus lumborum block is widely used as a component of perioperative anesthesia in abdominal surgery in adults, and is not commonly used in pediatric practice. The purpose of our research is to study the anato­mic features of quadratus lumborum space and the distribution of local analgesics in it, depending on the dose administered. The results can provide an opportunity to find the most effective and the safest dose of drugs for anesthesia. Materials and methods. The study was conducted on 12 corpses of people of different sex and age (20–73 years), whose death wasn’t violent. Thereupon, topographic-anatomical features of the muscles, fascial-cellular spaces, vessels and nerves within the lumbar region were studied using the method of preparation. The layer preparation of lumbar tissue was performed. Then, after the target anatomic structures had been visualized with the help of ultrasound in the in-plane technique, a methylene blue was introduced using the needle 22 G in the anterior medial direction, in the lateral position on the posterior edge of the quadratus lumborum (quadratus lumborum block) to study the simulated distribution of local anesthetic. Statistical processing of the data obtained was carried out using the methods of variation statistics implemen­ted in the Statistica 5.5 software (owned by National Pirogov Memorial Medical University, Vinnytsia, license AXXR910A374605FA). Results. The square of quadratus lumborum was studied, it ranged from 10.4 to 14.3 cm2 and averaged 12.01 ± 2.30 cm2. The study of the distribution of the solution in the space of quadratus lumborum, depending on the dose, showed that at a dose of 0.2 ml per 1 kg body weight, the area of average distribution of the solution was only 6.2 ± 2.1 cm2, which does not allow fil­ling the axis space by solution, and when using a dose of 0.3 ml per 1 kg body weight, the average distribution of the solution is 12.1 ± 1.4 cm2, which is quite consistent with the average area of the investigated space. Conclusions. The study of the distribution area of the solution in the space of the quadratus lumborum muscle suggests that local anesthetic at a dose of 0.3 ml per 1 kg body weight will be sufficient for anesthesia. This dose is safe for use in both adult and pediatric patients. Clinical efficacy needs further study.


regional anesthesia; post-mortem examination; quadratus lumborum block; analgesia


Khasabov S.G., Wang J.C., Simone D.A., Strichartz G.R. Aroleforneurokinin-1 receptor neurons in the rostral ventromedial medulla in the development of chronic postthoracotomy pain. Pain. 2017. Vol. 158(7).

Кучин Ю.Л. Седація під час регіональної анестезії у пацієнтів з поєднаними пошкодженнями. Science Rise. Medical Science. 2015. № 2(4). С. 68-73.

Kulshrestha A., Bajwa S.J.S. Management of acute post­operative pain in pediatric patients. Anesth. Pain. Intens Care. 2014. Vol. 18(1). P. 101-5.

Simić D., Stević M., Stanković Z. et al. The Safety and Efficacy of the Continuous Peripheral Nerve Block in Postoperative Analgesia of Pediatric Patients. Front. Med. 2018. № 5(57).

Krige A., Scott М. Anatomy of the Innervation of the Abdomen. Springer. 2018. P. 272.

Oliver L.-A., Oliver J.-A., Rayaz H., Lichtor J.L. Essentials of Regional Anesthesia. Pediatric Pain. Springer. 2018. P. 655-682.

Brockel M.A., Polaner D.M., Vemulakonda V.M. Anesthesia in the Pediatric Patient. Urol. Clin. North. 2018. № 45(4). P. 551-560.

Giaufre E., Dalens B., Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists. Anesth. Analg. 1996. № 83(5). P. 904-12.

Llewellyn N., Moriarty А. The national pediatricepidural audit. Paediatr. Anaesth. 2007. № 17(6). P. 520-33.

Brockel M.A., Polaner D.M., Vemulakonda V.M. Anesthesia in the Pediatric Patient. Urol. Clin. North. 2018. № 45(4). P. 551-560.

Rigg J.R., Jamrozik K., Myles P.S. et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. MASTER Anaethesia Trial Study Group. 2002. № 359(9314). P. 1276-82.

Valero V., Amini N., Spolverato G. et al. Sarcopenia adversely impacts postoperative complications following resection or transplantation in patients with primary liver tumors. J. Gastrointest. Surg. 2015. № 19(2). P. 272-81.

Triffterer L., Marhofer P., Willschkeet al. Ultrasound-guided cannulation of the great saphenous vein at the ankle in infants. Br. J. H. Anaesth. 2012. № 108(2). P. 290-4.

De Oliveira G.S., Castro-Alves L.J., Khan J. H., McCarthy R.J. Perioperative Systemic Magnesium to Minimize Post­ope­rative Pain: A Meta-analysis of Randomized Controlled Trials. Anesthesiology. 2013. Vol. 119. P. 178-190.

Русак П.С., Рибальченко В.Ф., Притула В.П. Інформація про конференцію «Сучасні аспекти надання хірургічної допомоги дітям». Хірургія дитячого віку. 2015. № 1/2. С. 132-133.

Курочкін М.Ю. Концепція антистресової збалансованої анестезії у новонароджених та немовлят. Вісник проблем біології і медицини. 2015. Вип. 2(1). С. 29-33.

Дмитрієв Д.В., Коноплицький В.С., Янович В.П. Спосіб визначення площі гіпералгезії післяопераційної рани у дітей. Пат. 112114 Україна МПК51 А 61 K 31/00. Заявник і патентовласник Вінницький нац. мед. ун-т. № U 201214624; опубл. 25.07.2016, Бюл. № 8. 4 с. Патент на винахід.

Ueshima H., Otake H., Lin J.A. Ultrasound-Guided Quadratus Lumborum Block: An Updated Review of Anatomy and Techniques. BioMed Research International. 2017. 2017. 2752876. doi: 10.1155/2017/2752876.

Chin K.J., McDonnell J.G., Carvalho B., Sharkey A., Pawa A., Gadsden J. Essentials of our current understanding: abdominal wall blocks. Regional anesthesia and pain medicine. 2017. № 42(2). Р. 133-183.

Blanco R., Ansari T., Riad W., Shetty N. Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery: a randomized controlled trial. Reg. Anesth. Pain. Med. 2016. № 41. Р. 757-62.

Adhikary S.D., El-BoghdadlyK., Nasralah Z., Sarwani N., Nixon A.M., Chin K.J. A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers. Anaesthesia. 2017. № 72. Р. 73.

Murouchi T., Iwasaki S., Yamakage M. Quadratus lumborum block: analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery. Reg. Anesth. Pain. Med. 2016. № 41. Р. 146-50.

Blanco R., Ansari T., Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: a randomised controlled trial. European Journal of Anaesthesiology (EJA). 2015. Vol. 32(11). Р. 812-818.

Sebbag I., Qasem F., Dhir S. Ultrasound guided quadratus lumborum block for analgesia after cesarean delivery: case series. Rev. Bras. Anestesiol. 2017. № 67. Р. 418-21.

Maenchen N., Hansen C.K., Dam M., Børglum J. Ultrasound-guided transmuscular quadratus lumborum (TQL) block for pain management after caesarean section. Int. J. Anesth. Anesthesiol. 2016. 3(048.10). 23937.

Ishio J., Komasawa N., Kido H., Minami T. Evaluation of ultrasound-guided posterior quadratus lumborum block for postoperative analgesia after laparoscopic gynecologic surgery. Journal of Clinical Anesthesia. 2017. № 41. Р. 1-4.

Carney J., Finnerty O., Rauf J., Bergin D., Laffey J.G., McDonnell J.G. Studies on the spread of localanaes the ticsolution in trans versus abdominisplane blocks. Anaesthesia. 2011. Vol. 66(11). Р. 1023-1030.

Kumar A., Sadeghi N., Wahal C., Gadsden J., Grant S.A. Quadratus lumborum spares paravertebral space in fresh cadaver injection. Anesth. Analg. 2017. № 125. Р. 708-9.

Tamura T., Shuichi Y., Ito S., Shibata Y., Nishiwaki K. A crossover healthy volunteers study of quadratus lumborum block to detect the paravertebral space dissemination. In ASA Annual Meeting, Boston. 2017, October.

Tesarz J., Hoheisel U., Wiedenhöfer B., Mense S. Sensory innervation of the thoracolumbar fascia in rats and humans. Neuroscience. 2011. № 194. 302-8.10.1016/j.neuroscience.2011.07.066.

Loukas M., Tubbs R.S., El-Sedfy A., Jester A., Polepalli S., Kinsela C., Wu S. The clinical anatomy of the triangle of Petit. Hernia, 2007. Vol. 11(5). Р. 441-444.

Blanco R., Ansari T., Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: a randomised controlled trial. Eur. J. Anaesthesiol. 2015. № 32. Р. 812-8.

Ueshima H., Otake H., Lin J.A. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. BioMed Research International. 2017.

Chin K.J., McDonnell J.G., Carvalho B., Sharkey A., Pawa A., Gadsden J. Essentials of our current understanding: abdominal wall blocks. Reg. Anesth. Pain. Med. 2017. № 42. Р. 133-83.

Børglum J., Moriggl B., Jensen K., Lönnqvist P.A., Christensen A.F., Sauter A. et al. Ultrasound-guided transmuscular quadratus lumborum blockade. Br. J. Anaesth. 2013. № 110. Р. 3.

La Colla L., Uskova A., Ben-David B. Single-shot quadratuslumborum block for postoperative analgesia after minimally invasive hip arthroplasty: a new alternative to continuous lumbar plexus block. Reg. Anesth. Pain. Med. 2017. № 42. 125-6.10.1097.

Murouchi T. Reply to Dr El-Boghdadly et al. Reg. Anesth. Pain. Med. 2016.

Абрикосов А.И. Техника патологоанатомических вскрытий трупов. Москва, 1948. 168 с.

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