ESRA Academy. Dam M. Sep 8, 2016; 138328; 0162 Topic: Trunk Blocks
Dr. Mette Dam
Dr. Mette Dam

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Background and Aims:

The pattern of spread of local anesthetic resulting from a Transmuscular Quadratus Lumborum (TQL) block has never been examined. The aims of this cadaveric study were to investigate (1)which pathway the injectate followed into the thoracic paravertebral space (TPVS), (2)whether the thoracic and lumbar sympathetic trunks and lumbar plexuses were dyed by the injectate (3)which nerves were dyed by the injectate cephalad and caudad to the diaphragm.


Ultrasound-guided bilateral TQL blocks were performed in five cadavers(figure 1). The ultrasound beam of the curvilinear-transducer was oriented in the transverse plane above the iliac crest at the posterior axillary line. The needle was advanced in-plane to the ultrasound beam with the endpoint of injection inside the interfascial space between the quadratus lumborum and psoas major muscles. Thirty mL of dye solution was injected bilaterally. The spread of the dye was evaluated by subsequent dissection.


In all cases, the dye spread into the TPVS surrounding the somatic nerves and the thoracic sympathetic trunk and the main pathway of spread was posterior to the arcuate ligaments(figure 2). Injected dye surrounded the subcostal, iliohypogastric and ilioinguinal nerves in all cases. 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(figure 3)



Spread of injectate into the TPVS occurs predominantly posterior to the arcuate ligaments and reach the somatic nerves and the thoracic sympathetic trunk inside the TPVS. The lumbar plexus and lumbar sympathetic trunk are not affecte

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