Save
PERIRENAL HEMORRAGE AFTER QLB1
Author(s): ,
Costa, F.*
Affiliations:
University Campus Bio-Medico, anesthesia, Rome, Italy
,
DEL BUONO, R.
Affiliations:
University Campus Bio-Medico, anesthesia, Rome, Italy
,
PASCARELLA, G.
Affiliations:
University Campus Bio-Medico, anesthesia, Rome, Italy
,
CECCA, S.
Affiliations:
University Campus Bio-Medico, anesthesia, Rome, Italy
,
MASCIANA', G.
Affiliations:
University Campus Bio-Medico, surgery, Rome, Italy
Agrò, F.
Affiliations:
University Campus Bio-Medico, anesthesia, Rome, Italy
ESRA Academy. Costa F. Sep 13, 2017; 190723; 519 Topic: Anticoagulation- Haemorrhagic Complications
Dr. Fabio Costa
Dr. Fabio Costa

Access to Premium content is currently a membership benefit.


Click here to join ESRA or renew your membership.

Abstract
Discussion Forum (0)
Rate & Comment (0)
Background and Aims:

Regarding the ERAS protocol for patients undergoing laparoscopic colo-rectal surgery, we perform a bilateral QL1 or a bilateral dual TAP block 1,2. We report a case of retroperitoneal hemorrhage after a QL1 block.

Methods:

A 30-year-old male patient (160cm, 55Kg) with mental disorder and a multiple malformation syndrome, was scheduled for a laparoscopic hemicolectomy. Informed consent was obtained. After general anesthesia, a bilateral QLB 1 was performed.

A transverse ultrasound scan was obtained above the iliac crest on the posterior axillary line; an echogenic needle (stimuplex ultra 360; 100 mm) was inserted from the midaxillary line directed posteriorly, injecting the local anesthetic below the thoracolumbar fascia laterally to the QL muscle. After 35 minutes and just after pneumoperitoneum the patient developed hypotension and tachycardia; the surgeon noted a right retroperitoneal hematoma formation.

Laparotomic exploration revealed a hematoma ranging from the right kidney, passing on the aortic carrefour until the left psoas muscle (fig.1). Apparently, bleeding started from an ectopic inferior polar artery injury of the right kidney.

Results:

In literature, trocar-induced injury is a known complication of laparoscopy 3,4. To date, few complications of the QL block are reported but they cannot be excluded 5. It is possible that mechanical ventilation pushed the kidney (fig.2) toward the needle, providing the injury. 

Conclusions:

This complication occurred after QL1 and trocar insertion. Both could have triggered the hemorrhage, but neither can be excluded. We suggest extreme caution in performing a right QLB1 (lateral QLB) in mechanically ventilated thin patients.

Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.



Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.


Save Settings