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 Table of Contents    
RESPONSE TO COMMENTS
Year : 2018  |  Volume : 62  |  Issue : 8  |  Page : 648  

Response to comments: Quadratus lumborum block failure: ‘A must know complication’


1 Department of Anesthesia, Institute of Liver and Biliary Sciences, New Delhi, India
2 Department of Oncoanesthesia, AIIMS, New Delhi, India
3 Department of Anaesthesia, SGPGI, Lucknow, Uttar Pradesh, India

Date of Web Publication13-Aug-2018

Correspondence Address:
Dr. Gaurav Sindwani
Department of Anesthesia, Institute of Liver and Biliary Sciences, New Delhi - 110 070
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_390_18

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How to cite this article:
Sindwani G, Suri A, Sahu S. Response to comments: Quadratus lumborum block failure: ‘A must know complication’. Indian J Anaesth 2018;62:648

How to cite this URL:
Sindwani G, Suri A, Sahu S. Response to comments: Quadratus lumborum block failure: ‘A must know complication’. Indian J Anaesth [serial online] 2018 [cited 2020 May 29];62:648. Available from: http://www.ijaweb.org/text.asp?2018/62/8/648/238914



Sir,

We thank the readers for their critical comments.[1],[2] In response to the first question, quadratus lumborum block (QLB) can be given in four different approaches which are anterolateral or lateral QLB (type 1), posterior QLB (type 2), and anterior or transmuscular QLB (type 3). Recently, an intramuscular approach for QLB has been described which we referred to as the fourth approach.[3] In response to the second question, in the figure, we tried to keep the anatomy of ultrasound-guided QLB clear for the readers. One of the major landmarks for the ultrasound-guided QLB is the tapering of the transverse abdominis muscle and the beginning of the thoracolumbar fascia (TLF). Therefore, it is easy for the readers to understand the anatomy when all the three anterior abdominal wall muscles are seen along with the beginning of TLF and quadratus lumborum muscle in the same figure.

In response to the third query, ideally, the needle tip or catheter should be placed in between the quadratus lumborum muscle and the TLF,[4] and not in the deep recess covered by the peritoneum as the readers suggested. This is because there is considerable amount of fat in between the peritoneum and TLF. Moreover, there is no continuity of this space with that of the QLB space. Therefore, drug deposited in the deep recess cannot spread along the fascial plane. In type 3 QLB, drug is injected very near to the paravertebral space in between the quadratus lumborum muscle and psoas major muscle. Moreover, TLF also has a rich nerve supply. Therefore, it is still possible that type 3 QLB would still result in good analgesia even when type 1 QLB fails as the natural tendency of the drug is to spread more medially rather than laterally.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Jadon A, Ami M. In response to Quadratus lumborum block failure: “A must know complication”. Indian J Anaesth 2018;62:646-7.  Back to cited text no. 1
  [Full text]  
2.
Suri A, Sindwani G, Sahu S, Sureka S. Quadratus lumborum block failure: “A must know complication”. Indian J Anaesth 2017;61:1016-8.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Murouchi T. Quadratus lumborum block intramuscular approach for pediatric surgery. Acta Anaesthesiol Taiwan 2016;54:135-6.  Back to cited text no. 3
    
4.
Akerman M, Pejčić N, Veličković I. A review of the quadratus lumborum block and ERAS. Front Med (Lausanne) 2018;5:44.  Back to cited text no. 4
    




 

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