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DOES ADMINISTRATION OF ULTRASOUND-GUIDED (USG) TRANSMUSCULAR QUADRATUS LUMBORUM (TQL) BLOCK PREOPERATIVELY IN AWAKE PATIENTS REQUIRE INTRAVENOUS OPIOIDS?
Author(s): ,
Bernhoff, C.*
Affiliations:
Zealand University Hospital- University of Copenhagen, Department of Anaesthesiology, Roskilde, Denmark
,
Dam , M.
Affiliations:
Zealand University Hospital- University of Copenhagen, Department of Anaesthesiology, Roskilde, Denmark
,
Tanggaard, K.
Affiliations:
Zealand University Hospital- University of Copenhagen, Department of Anaesthesiology, Roskilde, Denmark
,
Finn, O.B.
Affiliations:
Zealand University Hospital- University of Copenhagen, Department of Anaesthesiology, Roskilde, Denmark
Jens, B.
Affiliations:
Zealand University Hospital- University of Copenhagen, Department of Anaesthesiology, Roskilde, Denmark
ESRA Academy. Bernhoff C. Sep 13, 2017; 190916; 308 Topic: Local anaesthesia
Mrs. Charlotte Bernhoff
Mrs. Charlotte Bernhoff

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Abstract
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Background and Aims:

Administration of ultrasound-guided (USG) blocks in awake versus in anaesthetized patients has been keenly discussed. In particular, whether administration of deep paravertebral blocks, like the Transmuscular Quadratus Lumborum (TQL) block, would require significant amounts of opioids if the TQL block is administered in awake patients. The aim of this prospective cohort analysis was to investigate whether TQL block can be administered preoperatively in awake patients with minimal discomfort and without the use of intravenous opioids.

Methods:

Seventy-four consecutive patients were included in a prospective cohort analysis. All patients were due to undergo major open or laparoscopic surgery (general, gynaecologic, plastic and urologic surgeries). All patients had agreed to awake preoperative unilateral or bilateral TQL block. Patients were asked to rate the pain/discomfort of the block procedure NRS (0-10).

Results:

None of the seventy-four patients had intravenous opioids. Only 5% had either 0.5 mg midazolam or 10 mg propofol intravenously. The pain/discomfort during the administration of the deep TQL block was rated NRS 2.17±1.9 (mean±SD).

 


Conclusions:


A deep paravertebral block like TQL block can be administered without the use of opioids preoperatively in the block room, since correct performance of TQL block elicits only very mild pain. Importantly, if the block procedure is not performed correctly (i.e. intramuscularly), most likely the patients will report moderate to severe pain due to the high volume associated with TQL block, hence warning the anaesthesiologist of a wrongful procedure.

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