DOI: https://doi.org/10.22141/2224-0586.4.99.2019.173941

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

Abstract


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.


Keywords


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

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