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#35753 Fair and Square – an effective alternative analgesia to an unfeasible epidural
  1. Ana Inês Proença Pinto,
  2. Fernando José Almeida e Cunha,
  3. Margarida Ferreira and
  4. Daniela Cristina Simões Ferreira
  1. Anaesthesiology, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal


Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims We present the case of a 22-year-old who sustain a motorcycle accident with bilateral pelvic fracture and hemoperitoneum. A quadratus lumborum block (QLB) was performed as alternative to an analgesic epidural block.

Methods QLB leads to significantly better outcomes in terms of postoperative VAS scores, opioid consumption, rescue analgesic requirements and patient satisfaction when compared to Transversus Abdominis Plane Block due to its effect that may extend from T7 to L1–L2 dermatomes. The anterior approach spreads to the lumbar nerve roots in addition to the thoracic paravertebral space. The ultrasound-guided erector spinae plane block is considered as efficient as the anterior QLB, but, as with epidural block, they cannot be performed in dorsal decubitus.

Results The patient, an ASA II, with no relevant prior medical history, presented to the emergency department with a splenic laceration grade III (American Association for the Surgery of Trauma (AAST)) splenic injury scale. An open splenectomy was performed through a vertical midline incision, for exploratory laparotomy. Additionally, the patient had a left iliac and a right acetabular fractures with indication for conservative management, but their presence did not allow for a sitting or lateral decubitus positioning for insertion of an epidural or an erector spinae plane block.

Abstract #35753 Figure 1

Quadratus lumborum anterior block. Quadratus lumborus muscle in blue, Psoas muscle in yellow

Conclusions As an alternative, a bilateral QLB was performed under ultrasound guided technique. The chosen block was the QLB anterior with ropivacaine 0.375% 20ml, bilaterally, within a multimodal analgesic strategy combined with intravenous analgesia. The analgesic effect was satisfactory within the following 48 hours and no adverse effects were found.

Attachment patient consent.pdf

  • quadratus lumborum block
  • splenectomy

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