![]() Proper placement results in the spread of local anesthetic between QL and the middle layer of the TLF.įor the anterior QLB, the patient is placed in the lateral decubitus position with the ultrasound probe placed above the iliac crest at the mid-axillary line. The 3 abdominal muscle layers (external oblique, internal oblique, transversus abdominis) are identified and traced posteriorly to identify the TLF and the back muscles – QL, PM, ES, and latissimus dorsi). The provider inserts the needle in an in-plane approach and advances it through the anterior abdominal muscles until it reaches the anterolateral edge of QL. To acquire the ultrasound view for this block, the clinician should obtain the "shamrock sign," which consists of the transverse process of L4 as the "stem" and psoas major, QL, and erector spinae as "3 cloves of the shamrock." QL4 or intramuscular QL block involves the injection into the muscle itself.įor the lateral QLB, the patient is positioned supine or lateral position)with an ultrasound probe applied to the flank between the costal margin and the iliac crest in the anterior axillary line (triangle of Petit). QL2 or posterior QLB refers to injection posterior to the QL muscle (anterior to the TLF separating QL muscle from erector spinae and latissimus dorsi muscles) in an area termed the "lumbar interfascial triangle." Q元 or anterior QLB, also referred to as the transmuscular approach due to the typical needle approach, refers to injection anterior to the QL muscle at the level of the L4 vertebral body. QL1 or lateral QLB refers to the deposition of local anesthetic lateral to the QL muscle. Variants of this block have been described, each involving a different injection site relative to the quadratus lumborum muscle. The spread of local anesthetic to the paravertebral space and inhibition of these sympathetic fibers is believed to be responsible for the visceral pain coverage provided by this block. The TLF contains mechanoreceptors, nociceptors, and sympathetic fibers. The TLF extends from the lumbar spine to the thoracic spine in a craniocaudal direction. It has 3 layers – anterior, middle, and posterior – based on its relation to the back muscles it encapsulates. The TLF extends posteriorly to connect with the lumbar paravertebral region. It is also referred to as an interfascial plane block because it requires the injection of a local anesthetic into the thoracolumbar fascia (TLF), which is a posterior extension of the abdominal wall muscle fascia and encompasses the back muscles (quadratus lumborum, psoas major , and the erector spinae muscles). It is a block of the posterior abdominal wall.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |