Quadratus lumborum block: are we aware of its side effects? A report of 2 cases
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Revista Brasileira de Anestesiologia (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942018000400396 |
Resumo: | Abstract Background and objectives The quadratus lumborum block was initially described in 2007 and aims at blocking the same nerves as the ones involved on the Transverse Abdominis Plane block, while accomplishing some visceral enervation as well due to closer proximity with the neuroaxis and sympathetic trunk. Given its versatility, we have successfully used it in a wide range of procedures. We report two cases where we believe the dispersion of local anesthetic is likely to have led to a previously undescribed complication. Clinical reports We report two cases in which we performed a quadratus lumborum type II block and general anesthesia for total gastrectomy and right hemicolectomy. There were no noteworthy events while performing the block and inducing general anesthesia, but within 30-40 min serious hypotension and tachycardia were noted. As other motives for hypotension were ruled out, the event was interpreted as block-induced sympatholysis due to cephalad dispersion of the local anesthetic to the paravertebral and epidural space, and successfully managed with ephedrine and increase of the crystalloid infusion rate. Conclusions The quadratus Lumborum block is safe to execute and provides effective abdominal wall and visceral analgesia. However, the possibility of eliciting undesired episodes should prompt caution when performing this block and practitioners should thereafter remain vigilant. Questions regarding ideal dosing, volumes, timing of block and pertinence of catheters remain to be answered. |
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Quadratus lumborum block: are we aware of its side effects? A report of 2 casesQuadratus lumborumUltrasoundPainRegional anesthesiaPeripheral nerve blockAbstract Background and objectives The quadratus lumborum block was initially described in 2007 and aims at blocking the same nerves as the ones involved on the Transverse Abdominis Plane block, while accomplishing some visceral enervation as well due to closer proximity with the neuroaxis and sympathetic trunk. Given its versatility, we have successfully used it in a wide range of procedures. We report two cases where we believe the dispersion of local anesthetic is likely to have led to a previously undescribed complication. Clinical reports We report two cases in which we performed a quadratus lumborum type II block and general anesthesia for total gastrectomy and right hemicolectomy. There were no noteworthy events while performing the block and inducing general anesthesia, but within 30-40 min serious hypotension and tachycardia were noted. As other motives for hypotension were ruled out, the event was interpreted as block-induced sympatholysis due to cephalad dispersion of the local anesthetic to the paravertebral and epidural space, and successfully managed with ephedrine and increase of the crystalloid infusion rate. Conclusions The quadratus Lumborum block is safe to execute and provides effective abdominal wall and visceral analgesia. However, the possibility of eliciting undesired episodes should prompt caution when performing this block and practitioners should thereafter remain vigilant. Questions regarding ideal dosing, volumes, timing of block and pertinence of catheters remain to be answered.Sociedade Brasileira de Anestesiologia2018-08-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942018000400396Revista Brasileira de Anestesiologia v.68 n.4 2018reponame:Revista Brasileira de Anestesiologia (Online)instname:Sociedade Brasileira de Anestesiologia (SBA)instacron:SBA10.1016/j.bjane.2016.09.008info:eu-repo/semantics/openAccessSá,MiguelCardoso,José MiguelReis,HugoEsteves,MartaSampaio,JoséGouveia,IsabelCarballada,PilarPinheiro,CéliaMachado,Duarteeng2018-07-23T00:00:00Zoai:scielo:S0034-70942018000400396Revistahttps://www.sbahq.org/revista/https://old.scielo.br/oai/scielo-oai.php||sba2000@openlink.com.br1806-907X0034-7094opendoar:2018-07-23T00:00Revista Brasileira de Anestesiologia (Online) - Sociedade Brasileira de Anestesiologia (SBA)false |
dc.title.none.fl_str_mv |
Quadratus lumborum block: are we aware of its side effects? A report of 2 cases |
title |
Quadratus lumborum block: are we aware of its side effects? A report of 2 cases |
spellingShingle |
Quadratus lumborum block: are we aware of its side effects? A report of 2 cases Sá,Miguel Quadratus lumborum Ultrasound Pain Regional anesthesia Peripheral nerve block |
title_short |
Quadratus lumborum block: are we aware of its side effects? A report of 2 cases |
title_full |
Quadratus lumborum block: are we aware of its side effects? A report of 2 cases |
title_fullStr |
Quadratus lumborum block: are we aware of its side effects? A report of 2 cases |
title_full_unstemmed |
Quadratus lumborum block: are we aware of its side effects? A report of 2 cases |
title_sort |
Quadratus lumborum block: are we aware of its side effects? A report of 2 cases |
author |
Sá,Miguel |
author_facet |
Sá,Miguel Cardoso,José Miguel Reis,Hugo Esteves,Marta Sampaio,José Gouveia,Isabel Carballada,Pilar Pinheiro,Célia Machado,Duarte |
author_role |
author |
author2 |
Cardoso,José Miguel Reis,Hugo Esteves,Marta Sampaio,José Gouveia,Isabel Carballada,Pilar Pinheiro,Célia Machado,Duarte |
author2_role |
author author author author author author author author |
dc.contributor.author.fl_str_mv |
Sá,Miguel Cardoso,José Miguel Reis,Hugo Esteves,Marta Sampaio,José Gouveia,Isabel Carballada,Pilar Pinheiro,Célia Machado,Duarte |
dc.subject.por.fl_str_mv |
Quadratus lumborum Ultrasound Pain Regional anesthesia Peripheral nerve block |
topic |
Quadratus lumborum Ultrasound Pain Regional anesthesia Peripheral nerve block |
description |
Abstract Background and objectives The quadratus lumborum block was initially described in 2007 and aims at blocking the same nerves as the ones involved on the Transverse Abdominis Plane block, while accomplishing some visceral enervation as well due to closer proximity with the neuroaxis and sympathetic trunk. Given its versatility, we have successfully used it in a wide range of procedures. We report two cases where we believe the dispersion of local anesthetic is likely to have led to a previously undescribed complication. Clinical reports We report two cases in which we performed a quadratus lumborum type II block and general anesthesia for total gastrectomy and right hemicolectomy. There were no noteworthy events while performing the block and inducing general anesthesia, but within 30-40 min serious hypotension and tachycardia were noted. As other motives for hypotension were ruled out, the event was interpreted as block-induced sympatholysis due to cephalad dispersion of the local anesthetic to the paravertebral and epidural space, and successfully managed with ephedrine and increase of the crystalloid infusion rate. Conclusions The quadratus Lumborum block is safe to execute and provides effective abdominal wall and visceral analgesia. However, the possibility of eliciting undesired episodes should prompt caution when performing this block and practitioners should thereafter remain vigilant. Questions regarding ideal dosing, volumes, timing of block and pertinence of catheters remain to be answered. |
publishDate |
2018 |
dc.date.none.fl_str_mv |
2018-08-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942018000400396 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942018000400396 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1016/j.bjane.2016.09.008 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Anestesiologia |
publisher.none.fl_str_mv |
Sociedade Brasileira de Anestesiologia |
dc.source.none.fl_str_mv |
Revista Brasileira de Anestesiologia v.68 n.4 2018 reponame:Revista Brasileira de Anestesiologia (Online) instname:Sociedade Brasileira de Anestesiologia (SBA) instacron:SBA |
instname_str |
Sociedade Brasileira de Anestesiologia (SBA) |
instacron_str |
SBA |
institution |
SBA |
reponame_str |
Revista Brasileira de Anestesiologia (Online) |
collection |
Revista Brasileira de Anestesiologia (Online) |
repository.name.fl_str_mv |
Revista Brasileira de Anestesiologia (Online) - Sociedade Brasileira de Anestesiologia (SBA) |
repository.mail.fl_str_mv |
||sba2000@openlink.com.br |
_version_ |
1752126630027853824 |