Block It Like It’s Hot: Regional Anesthesia, Pain Medicine & POCUS S2:E8 "Keep It On the QL: The Secrets of Abdominal Wall Blocks (Part III)"
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Sep 15, 2024 In this engaging discussion, Amit, who specializes in ESP techniques, and Jeff, a creator of instructional content on QL block procedures, explore the intricacies of quadratus lumborum blocks. They unpack the intriguing differences between QL 1, 2, and 3, and even introduce the whimsical concept of a "Tequila block." With a mix of medical insights and humor, they also share lighthearted travel tales and dad jokes, making serious topics more relatable and entertaining.
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When To Choose A QL Block
- Use QL blocks for extensive or multi-quadrant abdominal surgery with visceral pain components.
- Inject large volumes (≈30 mL per side) at low concentration and consider dexamethasone and epinephrine as vascular marker and adjuvant.
How QL Achieves Abdominal Spread
- Anterior QL can produce abdominal analgesia because injectate can track cephalad to lower thoracic paravertebral zones.
- Success depends on correct plane, high volume, and reaching the area near the 12th rib and paravertebral space.
Scan Posteriorly Using Bones
- Use bony landmarks (spinous and transverse processes) and posterior scanning to avoid confusing soft-tissue planes in high BMI patients.
- Start posteriorly and follow the QL off the tip of the transverse process to locate the correct plane.