ESRA Academy. Gorecha M. Sep 8, 2016; 138566; 0439 Topic: Ultrasound
Dr. Mahul Gorecha
Dr. Mahul Gorecha

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Background and Aims:

Laparoscopic abdominal procedures such as appendectomy are very common nowadays, however adequate pain control can sometimes be difficult and often these patients require opiates. We present the case of a 53 year-old patient who underwent a laparoscopic appendectomy under general anaesthetic with a bilateral quadratus lumborum block requiring no morphine.


After induction of anaesthesia, a quadratus Lumborum block was performed bilaterally with the patient lying in the supine position with a 120mm L-plex needle using a sonosite S-nerve ultrasound machine and 20ml of 0.25% levobupivacaine was injected on each side. The patient was given only fentanyl 100mcg at induction and intraoperative paracetamol 1g.


The operation was carried out successfully with no response to surgical stimulation and the patient remained haemodynamically stable.  No morphine was given and the patient was extubated and sent to recovery. The patient was reassessed in recovery once fully awake and she was comfortable and pain-free.


The quadratus lumborum block was first described by Professor Blanco in 2007 – indicating a potential space posterior to the abdominal wall muscles and lateral to the quadratus lumborum muscle.  It had been reported to provide pain relief in the distribution of T6 to L1 dermatomes, covering a wider sensory area compared to Transverse abdominal plane (TAP) block. In practice this appears to have a significant opioid-sparing potential for abdominal surgery and superiority over TAP block.

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