Yang Hun-Mu, Park Sang Jun, Yoon Kyung Bong, Park Kyoungun, Kim Shin Hyung
Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Pain Res Manag. 2018 Jun 11;2018:2368930. doi: 10.1155/2018/2368930. eCollection 2018.
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.
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.
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.
The alternative approach for QL blocks was able to achieve a comparable extent when compared to the conventional approach.
腰方肌（QL）阻滞是一种腹部躯干阻滞技术，主要为腹壁提供镇痛和麻醉。本尸体研究旨在比较在软防腐尸体中超声引导下QL阻滞不同进针方法之间的染料扩散情况。
随机分组后，一名经验丰富的麻醉医生在五具尸体的左侧或右侧进行了两次外侧、三次后侧和五次改良QL阻滞。改良进针方法的目标注射点与传统后侧QL阻滞相同，为腰筋膜三角，但进针轨迹不同。每次阻滞注射20毫升染料溶液。对腰部区域和腹部侧面进行解剖。
成功完成了10次阻滞。无论采用何种进针方法，所有阻滞中胸腰筋膜中层均被深度染色，但前层染色较少。改良进针方法更易使注射液扩散至腹横肌和腹横筋膜平面。尽管进针位置准确，但所有外侧QL阻滞均伴有一定量的肌肉内或皮下浸润。两次后侧QL阻滞显示胸腰筋膜后侧被深度染色，其中一次伴有明显的皮下染色。肋下神经、髂腹下神经和髂腹股沟神经大多受累，但所有阻滞中胸段椎旁间隙和腰丛均未受影响。
与传统方法相比，改良QL阻滞进针方法能达到相似的范围。
