A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers

Anaesthesia. 2017 Jan;72(1):73-79. doi: 10.1111/anae.13647. Epub 2016 Oct 12.

Abstract

We performed bilateral transmuscular quadratus lumborum blocks in six cadavers using iodinated contrast and methylene blue. Computed tomography imaging was performed in four cadavers and anatomical dissection was completed in five. This demonstrated spread to the lumbar paravertebral space in 63% of specimens, laterally to the transversus abdominis muscle in 50% and caudally to the anterior superior iliac spine in 63% of specimens. There was no radiographic evidence of spread to the thoracic paravertebral space. Anatomical dissection revealed dye staining of the upper branches of the lumbar plexus and the psoas major muscle in 70% of specimens. Further clinical studies are required to confirm if the quadratus lumborum block might be a suitable alternative to lumbar plexus block.

Keywords: abdominal wall blocks; anatomy; quadratus lumborum; regional anaesthesia; ultrasound-guided technique.

MeSH terms

  • Abdominal Muscles / diagnostic imaging
  • Abdominal Muscles / metabolism*
  • Abdominal Wall / diagnostic imaging
  • Cadaver
  • Coloring Agents / pharmacokinetics
  • Contrast Media / pharmacokinetics
  • Dissection
  • Humans
  • Lumbosacral Plexus / diagnostic imaging
  • Lumbosacral Plexus / metabolism
  • Methylene Blue / pharmacokinetics
  • Nerve Block / methods*
  • Tomography, X-Ray Computed
  • Ultrasonography, Interventional / methods

Substances

  • Coloring Agents
  • Contrast Media
  • Methylene Blue