ESRA Academy. Reis H. Sep 4, 2014; 57702; 0777 Topic: INTERVENTIONAL TECHNIQUES
Dr. Hugo Reis
Dr. Hugo Reis

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Background and aims

Myofascial pain syndrome (MPS) is characterized by chronic pain caused by multiple trigger points and fascial constrictions; focal point tenderness; pain upon trigger point palpation; referred pain; and limited range of motion.

We aimed to report a clinical case of lumbar MPS management, in an ambulatory patient, with the recently described Quadratus Lumborum Block Type II (QLB2).


50-year-old man with a history of lumbar back surgery, followed in chronic pain consult for severe lower back pain, with characteristics of MFS (bilateral paravertebral lumbar trigger points and gluteus/thigh referred pain).

Previous approaches included opioids, local infiltration, physiotherapy, acupuncture. In our consult, we proposed a bilateral QLB2.

The technique was performed without pre-medication, using echography, an 100 mm neddle, injecting in each side 5 cc of ropivacaíne (0,2%).


The procedure progressed uneventfully. The patient was evaluated one week later and he reported great satisfaction, with significantly improvement, maintaining a mild lower back pain. He wants to continue this kind of strategy.


In addition of QLB type 1 and especially type 2 being recent techniques, aimed to improve results for multi-modal analgesic regimens in post abdominal surgery, the report of use of this kind of peripheral nerve blocks in chronic pain management is even sparser.

In our first attempt we had a very positive outcome so far, that is encouraging to go on, but this is a single case. We need to grow our experience in the future, for any further conclusions.

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