A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks L. Carline, G.A. McLeod, C. Lamb British.

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A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks L. Carline, G.A. McLeod, C. Lamb British Journal of Anaesthesia Volume 117, Issue 3, Pages 387-394 (September 2016) DOI: 10.1093/bja/aew224 Copyright © 2016 The Author(s) Terms and Conditions

Fig 1 Schematic diagrams of quadratus lumborum 1 block (left), quadratus lumborum 2 block (centre), and transmuscular quadratus lumborum block. The yellow dot represents the needle tip position during injection. British Journal of Anaesthesia 2016 117, 387-394DOI: (10.1093/bja/aew224) Copyright © 2016 The Author(s) Terms and Conditions

Fig 2 Quadratus lumborum 1 block. Dye visualized as dark staining and nerve involvement highlighted by coloured paper. All needles pierced the external and internal oblique muscles. Dye spread in block 1A to the TAP plane and around the iliohypogastric nerve. Block 1B spread over the ilioinguinal nerve but mainly to the postero-medial and posterolateral surfaces of quadratus lumborum to the deep muscles of back. Spread associated with block 1B was insufficient for postoperative pain relief. Block 1C spread within the TAP plane but predominantly within the subcutaneous tissue surrounding the antero-lateral abdominal wall muscles and latissimus dorsi. British Journal of Anaesthesia 2016 117, 387-394DOI: (10.1093/bja/aew224) Copyright © 2016 The Author(s) Terms and Conditions

Fig 3 Quadratus lumborum 2 block. Dye visualized as dark staining and nerve involvement highlighted by coloured paper. All needle tips were placed appropriately. In block 2A dye dispersed predominantly within the subcutaneous tissue and was insufficient for postoperative pain relief. In contrast, blocks 2B and 2C spread within TAP plane and around the subcostal nerve. British Journal of Anaesthesia 2016 117, 387-394DOI: (10.1093/bja/aew224) Copyright © 2016 The Author(s) Terms and Conditions

Fig 4 Transmuscular quadratus lumborum block. Dye visualized as dark staining and nerve involvement highlighted by coloured paper. All blocks (3A to 3D) penetrated quadratus lumborum and dispersed medially towards the lumbar nerve roots. Extensive nerve involvement in all blocks. British Journal of Anaesthesia 2016 117, 387-394DOI: (10.1093/bja/aew224) Copyright © 2016 The Author(s) Terms and Conditions