Background and Aims The PROcedure-SPECific Pain ManagemenT (PROSPECT)1 and Drinking eating, mobilising (DREAM )2 fulfilment for Abdominoplasty by use of QL Blocks.The study aimed to observe the efficacy of abdominal blocks against the standard opiate based pain management strategy post Abdominoplasty. Our primary outcome assessed the total morphine use and Secondary outcomes include timing of morphine request, the incidence of nausea and vomiting/side effects.Somatic pain is transmitted by ventral rami of spinal nerves ,usually T10-L1 and traverses between QL and psoas muscles before entering transversalis fascia.The visceral pain return via inferior hypogastric plexus to enter spinal cord via T10-L1 spinal nerves.
Methods We retrospectively studied morphine requirements in patient records comparing 20 patients having Abdominoplasty with QL Block under USG vs no QL Block group . The transducer was placed in the transverse plane on the flank of the patient cranially to the iliac crest, at the level of the umbilicus perpendicular to the skin. The muscle layers of the abdominal wall were identified and QL was identified medial to the aponeurosis of Transverses abdominis.0.4 mL/kg 0.25% Levobupivacaine 30 mL under USG guidance with 21G Ultraplex 100 mm nerve block needle bilaterally.
Results Data analysis demonstrated a 40% opioid-sparing effect of the QL block during the first 24 hours postoperatively as compared to Non QL block group.
Conclusions USG guided QL blocks provide opiate sparing analgesia for Abdominoplasty surgery.Posteriorly placed TAP works better and last longer due to PVB spread. Opiate requirements are minimal and side effects reduced postoperatively with QL blocks .
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