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108 Post-cesarean section analgesia with quadratus lumborum block 5 in a puerperal woman: a case report
  1. L Vieira,
  2. B Alves and
  3. CR Almeida
  1. Centro Hospitalar Tondela Viseu, Viseu, Portugal


Background and Aims A 42-year-old pregnant woman refused neuroaxial anaesthesia for a scheduled cesarean section (c-section), therefore a balanced general anaesthesia was performed. The c-section was uneventful. Before extubation, in a supine position, an ultrasound guided lumbar bilateral quadratus lumborum block (QLB) 5 was performed with a single shot dose of 20 ml, per side, of ropivacaine 0,5%. During the first 24 hours post-operative, the patient remained comfortable, with paracetamol 1g every 8 hours, intravenously, without other analgesic medication.

Methods Different variations of QLB have been performed for analgesia after c-section, but Transmuscular QLB (T-QLB) is frequently chosen, due to long lasting duration and to better visceral analgesia, but the patient must be positioned in both lateral position alternately. 1

Results Recently Almeida et al,2 described the QLB5 and the LAlat Block, the latter not for abdominal pain, using the same sonoanatomy of the T-QLB, but maintaining the supine position. The anesthetic is injected from anterior/lateral to posterior/medial direction between the psoas major muscle (PMM) and the quadratus lumborum muscle (QLM) (figure 1). The insertion point at QLB5 is anterior to the probe. This approach (QLB5) provides similar dispersion as the T-QLB; the gravid uterus or other abdominal structure are easily avoided as with the T-QLB; this happens because QLM functions as a safe path for the needle.

Abstract 108 Figure 1

Ultrasound image showing performance of a modified anterior QLB, a novel QLB 5. ESM, Erector spinae muscle; LA, Local anaesthetic.

Conclusions The QLB5 is safe and allows prolonged abdominal (somatic and visceral) analgesia for post-c-section.

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