Background and aims An ultrasound-guided bilateral transmuscular quadratus lumborum (TQL) block provides analgesia of both the somatic and visceral nerves in the abdomen due to the spread of injectate to the thoracic paravertebral space.¹ A cadaveric study has previously showed no spread of injectate to the lumbar plexus.¹ Another research group has, without mentioning their block technique, described that 90% of their patients experience lower limb weakness when performing TQL blocks.² We wanted to survey the incidence of lower limb weakness when performing a pre-operative bilateral TQL block at our department.

Methods During one week of April 2019 it was registered whether patients having a pre-operative bilateral ultrasound-guided TQL blocks showed sign of lower limb motor weakness afterwards (ability to walk to the operating theatre).

Results Four patients had a pre-operative bilateral TQL-block with 2×30 mL 0.375% ropivacaine in our block room. All four patients (100%) were, after having a bilateral TQL block, able to walk independently from the holding area and into the operating theatre.

Conclusions From our mini survey, no patients showed sign of lower limb weakness after a pre-operative bilateral TQL-block. The TQL block is an advanced block and the previously described lower limb weakness might be due to an accidental lumbar plexus block.

References

1. Dam M, et al. The Pathway of Injectate Spread With the Transmuscular Quadratus Lumborum Block: A Cadaver Study. Anesth Analg 2017. Mar 8.

2. Ueshima H, Hiroshi O. Incidence of lower-extremity muscle weakness after quadratus lumborum block. J Clin Anesth 2018 Feb;44:104.