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Background and Aims Posterior Quadratus Lumborum block (QLB2) provides effective postoperative analgesia in patients undergoing abdominal wall surgeries. We present a case of motor and sensory loss following QLB2.
Methods A 24-year-old male, ASA IV, HT:185cm, BW:70Kg with unremarkable medical history underwent kidney transplantation due to autoimmune renal failure.Application of basic monitoring, induction and maintenance were performed according to standard practice. The patient being placed in lateral decubitus position, QLB2 was performed under ultrasound control prior to emergence with a high frequency linear probe (6-12Hz) placed in transverse orientation at the midaxillary line (MindrayTM TE9 Ultrasound System, China). Using an in-plane technique, the needle (Stimuplex® Ultra 22G-90mm, B. Braun,) was inserted toward the posterior aspect of the QL muscle. After aspiration, negative for blood, 20mL levobupivacaine 0.375%, 0.4 mL/Kg3 was administered. Emergence and extubation were uneventful.
Results The patient was evaluated using a Visual Analogue Scale (VAS) on the 1st, 4th, 8th, 12th and 24th postoperative hour. Pain was described mild in all assessments. Hip paresthesia was noticed on the 8th-h. On examination, absence of cold and light touch sensation extending from the upper abdomen to the knee (T7-L2) was recorded. Hip flexion and knee extension were deemed weak (power 4/5). Full mobilization was achieved by the 12th-h. Normal motor function was achieved by the 24th-h while sensory was resumed on the 36th-h.
Conclusions Possible local anesthetic spreading to the lumbar plexus affecting the femoral nerve and consequently psoas, iliacus and quadriceps muscles may has resulted in motor block. Pain was minimal without needing additional analgesia.
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