Quadratus Lumborum Block

Question 1

Useful application of QL block?

Answer 1

abdominal surgery
ant hip surgery

Question 2

what distribution do you get with QL block?

Answer 2

T6-L1

Question 3

Why is QL better than TAP block?

Answer 3

get full abdominal coverage with just one block.

TAP block often requires other blocks to get full coverage

also provides visceral pain relief

Question 4

how does QL block provide visceral pain relief?

Answer 4

from paravertebral spread

Question 5

What pain relief does QL block provide?

Answer 5

somatic pain relief to abdominal skin, muscles, and parietal peritoneum

visceral pain relief

Question 6

Which block is basically an extension of a TAP block?

Answer 6

QL block

Question 7

What are the anterior/lateral wall muscles you need to be aware of for QL block?

Answer 7

rectus abdominis
external abdominal oblique
internal abdominal oblique
transversus abdominis

Question 8

what are the posterior abdominal wall muscles/structures to be aware of for QL block?

Answer 8

erector spinae
psoas major
quadtratus lumborum
thoracolumbar fascia

Question 9

what is important to understand about the QL fascia?

Answer 9

it is continuous with the transversus abdominus fascia

Question 10

how many approaches are there for QL block?

Answer 10

3

Question 11

which block position has highest chance of paravertebral spread?

Answer 11

QL 3

Question 12

which block position has highest risk of peritoneal puncture?

Answer 12

QL 3

Question 13

which block position is the most superficial?

Answer 13

QL2

Question 14

which block position is the original?

Answer 14

QL1

Question 15

which US probe would you use for QL block? And why?

Answer 15

curved transducer

because block is usually 4-8cm deep
also helps keep the long needle in view so you don’t loose it.

Question 16

what dose of local for QL block?

Answer 16

20-40ml each side

Eddie usually uses 25ml on each side with great results

Question 17

what kind of needle do you use for QL block?

Answer 17

21g 110mm non-stimulating

Question 18

how should patient be positioned for QL block?

Answer 18

sitting, lateral decubitus, or supine

Question 19

in what postions is the QL more thin?

Answer 19

sitting and supine

Question 20

in what position is the QL the thickest?

Answer 20

lateral decubitus with hip abducted

Question 21

what other structure could you accidently hit on the Right side?

Answer 21

the liver

Question 22

what other structure could you accidently hit on the left side?

Answer 22

spleen

Question 23

what other structures could you potentially hit?

Answer 23

kindeys, liver, or spleen

Question 24

how could color flow help with this block?

Answer 24

help identify lumbar arteries that run on the post surface of the QL

Question 25

what could happen when larger volumes of LA are used in the QL block?

Answer 25

may get better paravertebral spread, but could also get lumbar plexus > leg weakness

Question 26

is there a specific billing code for QL blocks?

Answer 26

no, they are too new. Have to use the "other" code.

Question 27

Name the block and structures

Answer 27

QL block