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B196 Unsuspected spread after posterior quadratus lumborum block: a case report
  1. MT Fernandez Martín,
  2. L Leal,
  3. V Carbajosa,
  4. A Fernandez and
  5. J Mato
  1. Rio Hortega University Hospital, Valladolid, Spain


Background and Aims A 62-year-old man scheduled for an analgesic treatment inside a study carried out in our hospital about the impact of QL 2 in patients affected of chronic hip pain.

Methods After assessing, we performed the block ultrasound guided in the right side, placing 15 ml of levobupivacaine 0.25% + dexamethasone 4 mg between quadratus lumborum and latissimus dorsi muscles noticing the spread. After 30 minutes the patient was discharged.

Results One hour after the procedure the patient returned to our unit in wheelchair due to bilateral leg weakness. He arrived dizzy and bradycardic. He wasn´t able to stand even with the support of one person. On examination: bilateral sensory block, higher in the block side (right), with absent sensation to cold and markedly sensation to light touch from the grown to the knee (plexus lumborum innervation, L1-L3) and in hip flexion objectively weak (right: power 2–3/5; left 4/5). There was also subtle weakness of knee extension higher in the right side (2–3/5) than left one (3/5). Plantar extension and flexion without alteration and bilateral Babinski sign negative.

A CT scan was informed as normal except a bladder distension. Looking for the cause of the weakness we went over the scan noticing a slight edema in the thoracolumbar fascia to the spinal space.Normal motor function returned nine hours after block, being the patient discharged. At 24 hours we confirmed the total recovery.

Conclusions Therefore, based in the clinic and images we supposed an unsuspected spread of the local anesthetic to epidural space.

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