Quadratus Lumborum Block for Percutaneous Nephrostomy (QLB)

Quadratus Lumborum Block Versus Local Anesthetic Infiltration Combined With Monitored Anesthesia Care for Percutaneous Nephrostomy

Percutaneous nephrostomy (PCN) is one of the interventions in the radiology department in which pain control is necessary. Quadratus Lumborum (QL) block will be tried to limit the use of systemic analgesics and its accompanying untoward effects in those frail patients requiring PCN that is performed in the prone position.

Quadratus Lumborum block is a novel technique in which extension into the thoracic paravertebral space may occur. QL block would seem to be able to alleviate both somatic and visceral pain so it's expected to decrease the need for systemic sedation\analgesia to a minimum.

Nephrostomy; Complications, Upper Urinary Tract Dilatation and Obstruction, Regional Anesthesia Morbidity, Adverse Anesthesia Outcome

QL block with 0.25% levobupivacaine (Chirocaine, Abbott, Ireland) and 1% lignocaine MAC with IV Midazolam Img\ml and Fentanyl 10 mic\ml

A linear 12-MHz ultrasound probe will be placed in the anterior axillary line to visualize the typical triple abdominal layers. Then, the probe will be placed in the midaxillary line and at this point the layers of abdominal layers starte to taper. The probe will be placed in the posterior axillary line, sonoanatomy will show first the transversus abdominis disappearing then the internal oblique and external oblique forming aponeurosis and appearance of QL will be noticed. At the posterior border of the quadratus lumborum muscle and outside the fascia, Touhe needle will be inserted in plane and confirmed its position by injecting saline. Under ultrasound (US) guidance, local anesthetic mixure will be deposited separating the fascia

Verbal Rating Scale is assessed for degree of pain during the procedure and after till discharge from the radiology department.

Inclusion Criteria: ASA grade III and IV patients, Ureteral obstruction due to malignancy or secondary to urinary diversion after cystectomy Exclusion Criteria: Bleeding diathesis; INR more than than 1.5 and platelet count less than 100,000/mm3. Untreated urinary tract infection; Pre-operative haemoglobin <10 gm/dl, Severely co morbid patients Non-dilated renal collecting system Patient refusal to consent for the procedure.

Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol. 2013 Oct;29(4):550-2. doi: 10.4103/0970-9185.119148.

Ironfield CM, Barrington MJ, Kluger R, Sites B. Are patients satisfied after peripheral nerve blockade? Results from an International Registry of Regional Anesthesia. Reg Anesth Pain Med. 2014 Jan-Feb;39(1):48-55. doi: 10.1097/AAP.0000000000000038.