Author : Paolo Scimia
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (116 download)
Book Synopsis ULTRASOUND-GUIDED QUADRATUS LUMBORUM BLOCK: AN EFFECTIVE METHOD FOR POSTOPERATIVE ANALGESIA IN OPEN PYELOPLASTY by : Paolo Scimia
Download or read book ULTRASOUND-GUIDED QUADRATUS LUMBORUM BLOCK: AN EFFECTIVE METHOD FOR POSTOPERATIVE ANALGESIA IN OPEN PYELOPLASTY written by Paolo Scimia and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims:Anderson-Hynes open pyeloplasty (AHP) is a surgical technique for the management of uretero-pelvic junction obstruction (UPJO). In standard AHP, surgeon generally performs the opening of posterior abdominal muscles and detachment of parirenal fat. The large muscle cutting incision is the major cause of significant postoperative pain. Recent evidences suggested that Quadratus lumborum block type 1 (US-QLB 1) could provide effective postoperative analgesia in urological surgery. To test this hypothesis, we described a 52 year old man, ASA 2, who underwent AHP for treatment of a left UPOJ with severe hydronephrosis (grade IV).Methods:After induction of anesthesia with the patient in a right lateral position, we performed US-QLB 1 by injecting 20 ml of 0,5% Ropivacaine plus Dexamethasone 4 mg through a 22 gauge 80 mm needle in the fascial plane between the posterior edge of the transversus abdominis muscle, the quadratus lumborum muscle (QLM) and the underlying transversalis fascia (TF). We ultrasonically confirmed the spread of local anesthetic (LA) over the anterolateral surface of QLM and downward displacement of the retroperitoneal fat. Before the end of surgery, 1 g of acetaminophen and Ketorolac 30 mg were intravenously administered.ResultsPatient remained hemodynamically stable throughout the procedure and reported a prolonged pain relief after surgery, without opioids needing. No discomfort and complications were recorded postoperatively.Conclusions:This case report suggested that US-QLB 1, as part of a multimodal analgesic regimen, could provide long-lasting analgesia for AHP, likely due to a predominant spread of LA deep to TF in the retroperitoneal posterior pararenal space.Keywords:Ultrasound guidanceQuadratus Lumborum BlockPostoperative analgesiaPyeloplastyUretero-pelvic junction obstruction.