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AN UNEXPECTED LUMBOSACRAL PLEXUS BLOCK FOLLOWING ULTRASSOUND GUIDED TRANSMUSCULAR QUADRATUS LUMBORUM BLOCK- CASE REPORT
ESRA Academy. Thottungal A. Sep 8, 2016; 138586; 0464 Topic: Miscellaneous Complications/ Medicolegal
Dr. Athmaja Thottungal
Dr. Athmaja Thottungal

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Abstract
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Background and Aims:

Quadrats lumborum (QL) pain is a major cause of myofascial low back pain. Trigger point injection is the common procedure done to treat this. Transmuscular injection technique of doing quadratus lumborum block using ultrasound is described recently for acute pain management. Same technique could be used for intramuscular injection of QL to treat chronic low back pain.

Methods:

73 year old, ASA 2 female with LBA due to  left sided QL spasm had a transmuscular in plane approach injection of 30 ml of 0.25% L- bupivacaine and 80 mg of depomedrone performed under ultrasound guidance in to the muscle above the anterior fascial plane between QL and psoas major muscle in prone position.

Results:

Patient developed complete motor and sensory block of left leg similar to psoas compartment block after 20 minutes in the recovery ward. Patient was admitted for observation. The lumbosacral plexus involvement was complete and it resolved after 36 hours with full function returned. Patient had almost 90% low back pain relief and is continuing even after 8 weeks follow up.No further complications were noted.

Conclusions:

Quadratus Lumborum block is described as a analgesic method for abdominal surgery to cover T7-L1. The lumbar plexus passes anterior to the QL normally before descending down to the pelvic region. A possible explanation of the complication that this patient developed could be explained by the anatomical variation of lumbar plexus passing through the quadratus lumborum muscle rather than anterior to the psoas muscle.The prolongation of block is explained by addition of steroids.

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