Author(s): ,
Mullins , C.*
Sligo University Hospital, Anaesthesia, Sligo, Ireland
O'Brien , C.
Sports Surgery Clinic, Neurophysiology, Dublin, Ireland
O'Connor , T.
Sligo University Hospital, Anaesthesia, Sligo, Ireland
ESRA Academy. Mullins C. Sep 13, 2017; 190935; 419 Topic: Trunk Blocks
Cormac Mullins
Cormac Mullins

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Background and Aims:

Modalities that improve the accuracy of needle positioning reduce the risk of complications. This case describes the first use of combined needle electromyography (EMG) and ultrasound (US) to carry out a Quadratus Lumborum (QL) block, performed for post-operative analgesia following an open appendicectomy.


A nineteen-year-old male presented to a university teaching hospital with acute appendicitis and underwent an open appendicectomy. Following surgery, the patient was positioned for a quadratus lumborum block. Dantec™ Klavis™ EMG was connected to a Miobot™ 27G concentric needle EMG. Ultrasound Macro Maxx™ was prepared with a 6-13 Hz linear probe.


The needle was advanced using an in-plane technique with the needle tip visualised on US. As the needle was inserted into the EO muscle, a loud burst of noise was audible on the EMG speaker. This corresponded with a palpable “pop” sensation as the needle entered the EO muscle layer. The process was repeated with the IO muscle. 20mls of 0.25% levobupivacaine was injected.

The patient reported no pain immediately post-operatively. Sensory assessment of the anterior abdominal wall demonstrated a sensory block from T6 to L2.  This persisted for approximately 18 hours following surgery.



This case report demonstrates the first combined use of needle EMG and US for accurate needle positioning for QL block. We recommend that this novel technique be further assessed, ideally in a randomised controlled trial in comparison with the standard technique. We also suggest that this combined approach be assessed for other peripheral nerve blocks, as it may provide additional safety.

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