A novel ultrasound-guided lateral quadratus lumborum block in dogs: a comparative cadaveric study of two approaches |
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| Institution: | 1. Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA;2. Department of Anesthesia, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada;3. Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA;4. Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina;1. Veterinary Anesthesia and Analgesia Laboratory, Veterinary Sciences Graduate Program, Department of Veterinary Medicine, Federal University of Parana, Curitiba, PR, Brazil;2. Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada;1. Veterinary Sciences Graduate Program, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil;2. Anatomy Department, Biological Science Sector, Federal University of Paraná, Curitiba, PR, Brazil;1. Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA;2. Veterinary Anesthesia Services LLC, Jacksonville, FL, USA;3. Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina;1. Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA;2. Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA;3. Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Dublin, OH, USA |
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| Abstract: | ObjectiveTo describe an ultrasound-guided lateral quadratus lumborum (LQL) block technique and the spread characteristics of lidocaine–dye injected in the LQL plane using a transversal (LQL-T) or a longitudinal (LQL-L) approach.Study designExperimental anatomic study.AnimalsA total of eight canine cadavers.MethodsBilateral ultrasound-guided injections in the fascial plane lateral to the quadratus lumborum muscle and medial to the thoracolumbar fascia (LQL plane) with the needle directed at the first lumbar (L1) transverse process were performed using lidocaine–dye (0.3 mL kg?1). Anatomical dissection determined the dye distribution, sympathetic trunk staining and number of spinal nerves stained circumferentially >1 cm.ResultsThe LQL fascial plane was ultrasonographically recognized in all cadavers and filled with lidocaine–dye in all eight cadavers with the LQL-T approach and in six with LQL-L. The injectate spread ventral to the lumbar transverse processes, around the quadratus lumborum muscle and dorsal to the transversalis fascia, affecting the ventral branches of the spinal nerves and the sympathetic trunk. A median (range) of 4 (3–5) and 3 (0–4) ventral branches of the thoracolumbar nerves were dyed with LQL-T and LQL-L approaches, respectively (p = 0.04). The most cranial nerve stained was the twelfth thoracic (T12) with the LQL-T approach and T13 with LQL-L, and the most caudal was L3 with both approaches. The incidence of sympathetic trunk staining was significantly higher using LQL-T (six injections) compared with LQL-L (one injection; p = 0.04). Dye was not observed in the lumbar plexus, epidural space or abdominal cavity.Conclusions and clinical relevanceUltrasound-guided LQL-T approach resulted in a more consistent spread toward the spinal nerves and sympathetic trunk compared with LQL-L approach. Further studies are necessary to assess the LQL block effectiveness and success rate in live dogs. |
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| Keywords: | dog interfascial plane block quadratus lumborum block regional analgesia sympathetic block ultrasound |
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