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Local anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: a crossover volunteer study

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Abstract

Purpose

Previous work showed that 20 mL of local anesthetic (LA) did not spread into the paravertebral space (PVS) via the intramuscular quadratus lumborum block (QLBi). If spread of LA into the PVS can be achieved by increasing the total LA volume, QLBi can be more effective. We hypothesized that a larger volume of LA for the QLBi would spread into the PVS.

Methods

This crossover volunteer study included five healthy men. For comparison, both the ultrasound-guided QLB type 2 (QLB2) and QLBi were employed on opposite sides of each volunteer, and the spread of LA solution (0.7 mL/kg) mixed with contrast media in the PVS was assessed 1 h after the first injection using magnetic resonance imaging. Sensory loss was evaluated by pinprick 90 min post-injection. Each volunteer underwent both QLB types, and the same procedures were administered on opposite sides 7 days after the first experiment.

Results

In total, 20 QLB blocks (10 QLB2 and 10 QLBi) were performed. LA did not spread into the PVS after the QLBi. The sensory block area included the lower abdomen after the QLB2, but not after the QLBi. The sensory block area did not extend to the upper abdominal region or the midline of the lower abdomen with either block method.

Conclusion

LA administered by the QLB2 spreads into the PVS of T10–T12, resulting in lower and lateral abdominal sensory loss. In contrast, LA administered by the QLBi does not spread into the PVS and results in only lateral abdominal sensory loss.

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Acknowledgements

We thank Shusaku Baba, Atsushi Okamoto, Kenta Miyazaki, Hiroshi Usami, and Yohei Nishino for providing assistance with our nerve block maneuver. We also thank Koji Suzuki and Yusuke Kusaka for providing assistance with skiagraphy.

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Authors and Affiliations

  1. Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya, 466-8550, Japan

    Takahiro Tamura, Yasuyuki Shibata & Kimitoshi Nishiwaki

  2. Division of Anesthesia, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan

    Shuichi Yokota

  3. Division of Diagnostic Radiology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan

    Shigeki Ito

Authors
  1. Takahiro Tamura
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  2. Shuichi Yokota
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  3. Shigeki Ito
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  4. Yasuyuki Shibata
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  5. Kimitoshi Nishiwaki
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Correspondence to Takahiro Tamura.

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None of the authors has any conflicts of interest to declare in relation to this work.

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Tamura, T., Yokota, S., Ito, S. et al. Local anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: a crossover volunteer study. J Anesth 33, 26–32 (2019). https://doi.org/10.1007/s00540-018-2578-5

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  • DOI: https://doi.org/10.1007/s00540-018-2578-5

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