Author(s): ,
Dirzu, D.S.*
University of Medicine and Pharmacy Iuliu Hațieganu Cluj Napoca, Anesthesia and Intensive Care, Cluj Napoca, Romania
Dumulesc, C.
Emergency County Hospital Cluj Napoca, Anesthesia And Intensive Care, Cluj Napoca, Romania
ESRA Academy. Dirzu D. Sep 13, 2017; 190726; 535 Topic: PAIN THERAPY (ACUTE - CHRONIC)
Dr. Dan Sebastian Dirzu
Dr. Dan Sebastian Dirzu

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Background and Aims:

Victims of trauma often present with severe pain difficult to manage. Intravenous analgesia is sometimes ineffective and creates side effects. We present the case of a patient with intractable pain, secondary to pelvic, acetabular and femur fracture, managed with quadratus lumborum block (QL).


A 27 years old female, victim of trauma, was admitted with multiple injuries. Regardless of multimodal analgesia with boluses of paracetamol and ketorolac and continuous infusion of nefopam, fentanyl and ketamine, patient was presenting excruciating pain 4 days after injury. Pain was localised on the left hip and left lower limb above the knee, where she had pelvic and acetabular fracture and an external fixator for open comminuted fracture of the femur. She presented nausea, sedation, bradypnea with hypercapnia and she developed allodynia. Epidural analgesia was impossible because of immobilisation. We performed QL on the left side with the patient supine, anterior approach. 30 ml ropivacaine 0.25% were injected. Patient refused catheter placement, but accepted future injections if needed.


After performing the QL block the patient described excellent analgesia for 8 hours. Fentanyl and ketamine infusion were discontinued and side effects disappeared. When the effect of the block weaned off pain was described as medium, and responded to small boluses of fentanyl. No further blocks were necessary.


We used QL block to treat severe, intractable pain and side effects of intravenous analgesia in a patient with multiple injuries. We believe we interrupted a wind-up phenomenon and central sensitisation, already installed.

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