BACKGROUND: The spread of injectate resulting from a transmuscular quadratus lumborum (TQL) block and a transverse oblique paramedian (TOP) TQL block has never been examined. The aim of this cadaveric study was to investigate by which pathway the injectate spreads cephalad into the thoracic paravertebral space and which nerves were dyed by the injectate cephalad and caudad to the diaphragm when performing a TQL and a TOP TQL block. We also aimed to investigate whether the thoracic and lumbar sympathetic trunks as well as the lumbar plexus were covered by the injectate. METHODS: Ultrasound-guided bilateral TQL and TOP TQL injections were administered in 8 cadavers. A total of 16 injections were performed. With the TQL injection, the curvilinear transducer was oriented in the transverse plane above the iliac crest at the posterior axillary line to identify the Shamrock sign. With the TOP TQL injection, the same transducer was placed with a TOP orientation 3 cm lateral to the L2 spinous process to identify the L2 transverse process and the adjoining quadratus lumborum muscle. For both techniques, the needle was advanced in-plane to the transducer, with the end point in the interfascial plane between the quadratus lumborum and psoas major muscles. Thirty milliliters of dye solution was injected bilaterally for each technique. The spread of the dye was evaluated by subsequent dissection. RESULTS: In all successful injections, the dye was seen to spread into the thoracic paravertebral space and the intercostal spaces to surround the somatic nerves and the thoracic sympathetic trunk. The main pathway of spread of injectate was posterior to the medial and lateral arcuate ligaments. Caudad to the diaphragm, the injected dye surrounded the subcostal, iliohypogastric, and ilioinguinal nerves in all cases, whereas the genitofemoral and lateral femoral cutaneous nerves were dyed in a varying degree. No dye was seen to surround the lumbar plexus, femoral nerve, or lumbar sympathetic trunk. The pattern of spread was similar with the TQL and TOP TQL injections. CONCLUSIONS: The spread of injectate with the TQL and TOP TQL approaches is cephalad from the lumbar point of administration between the quadratus lumborum and psoas major muscles, predominantly via a pathway posterior to the arcuate ligaments and into the thoracic paravertebral space to reach the somatic nerves and the thoracic sympathetic trunk in the intercostal and paravertebral spaces. The lumbar plexus and lumbar sympathetic trunk are not affected. (C) 2017 International Anesthesia Research Society
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Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com
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- Construct validity—Current issues and recommendati...
- Universal versus targeted additional contact preca...
- Gestational diabetes mellitus: an updated overview
- Contrast reaction training in US radiology residen...
- Response to Tulchinsky and Avram re: “Long-Term Ou...
- Response to Tulchinsky and Avram re: “Long-Term Ou...
- Vaccine Development
- Cell membrane integrity and revascularization: The...
- Skill-related physical fitness versus aerobic fitn...
- Radical Dissection of Greater Palatine Artery and ...
- Unilateral Pterional Polycraniosynostosis Treated ...
- Usefulness of self-report questionnaires for psych...
- Dynamics of progesterone and estrogen receptor alp...
- Confined polymerization: ARGET ATRP of MMA in the ...
- Effect of compositions of acceptor polymers on dar...
- Synergistic dielectric and semiconducting properti...
- Organogelation of self-assembling segmented poly(u...
- Effect of transfer agent, temperature and initial ...
- Corrigendum to “Is meditation always relaxing? Inv...
- The relationship of approach/avoidance motivation ...
- The Incidence and Health Care Resource Burden of t...
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- Sucralose Suppresses Food Intake
- Precision Metabolism: Hitting the Mark
- Feeding the Genome: In Silico Optimization of Diet...
- Integrative Physiology: At the Crossroads of Nutri...
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- The element fluorine and its effects on human heal...
- A rare case of giant solitary calvarial plasmacyto...
- Two founders of Bombay Neurosciences: Professor Ga...
- A case of infectious intracranial dissecting aneurysm
- Hemichorea secondary to non-ketotic hyperglycemia ...
- Persistent trigeminal artery trunk giant aneurysm ...
- Deep tendon reflex: The background story of a simp...
- The 'reverse' evaluation!
- Description of coma and coma arousal therapy in Ca...
- Anaesthesia, chronic pain and brain connectivity
- Dyke–Davidoff–Masson syndrome
- Role of functional MRI in identifying network chan...
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- Traumatic brain injury in India: A big problem in ...
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- The role of systematic collection of epidemiologic...
- The cover page
- Quantitative research on traumatic brain injury in...
- Imaging biomarker correlates with oxidative stress...
- Impact of hyperglycemia on the efficacy of chemoth...
- Refining the indications for scapula tip in mandib...
- Influence of third molars in mandibular fractures....
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- Usefulness of self-report questionnaires for psych...
- Flexible heartbeat sensor for wearable device
- Chemical redox modulated fluorescence of nitrogen-...
- Simple, sensitive and label–free electrochemical d...
- Extensible multiplex real-time PCR for rapid bacte...
- A novel silver nanocluster in situ synthesized as ...
- Enhanced photocurrent production by the synergy of...
- Hybrid detection of target sequence DNA based on p...
- Can gene editing and silencing technologies play a...
- Correlation of Crtc1/3-Maml2 fusion status, grade ...
- Close surgical margin after conservative parotidec...
- Isotretinoin treatment for acne and risk of depres...
- Clinical similarity of biosimilar ABP 501 to adali...
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