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Um… thanks?

Hi Can you re-clarify the context of your question? Thanks

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I will quote from here: pubs.asahq.org/anesthesiology/article/130/2/322/20073/Quadratus-Lumborum-BlockAnatomical-Concepts "The proximity of quadratus lumborum block to the pleura and kidney in the subcostal anterior approach presents a risk because of direct needle trauma.10 The risks of bleeding complications are not yet known. There is no evidence for the stratification of the risk of bleeding based on quadratus lumborum approaches. The posterior and lateral quadratus lumborum block approaches use a fascial plane through which the abdominal branches of the lumbar arteries course. The anterior quadratus lumborum block is a deep block, close to the lumbar plexus and risks retroperitoneal spread of hematoma. Therefore, the authors recommend that, for all approaches, the American Society of Regional Anesthesia and Pain Medicine guidelines for deep peripheral blocks be followed." In summary, there are theoretical risks, but objectively there is no concrete evidence (yet) of increased complications with various QL blocks.

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point of injection of whether T10 or T11 doesnt make much of a difference coz the injected volume spread will carry it there anyway.. at least at a sonographic point of 4-5 TP caudad away from the end of rhomboids shd be enough if intention is for post op incisional wound analgesia at T12- L1

Tq Dr Azrin

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Tq Dr Azrin

Thanks for your input!

Intersting input... agree.. living and cadaveric tissues may provide different dynamics for fluid (ie LA) spread which may affect clinical presentation. Even when injections are done by the same operator, inter-individual patient variability may also affect clinical presentations observed. Ideally, in centres whereby the facility is available, contrast studies done immediately after injection is best to assess spread but unfortunately its not available in many centres and it is not practically possible due to logistic reasons. As for choice of block, those 2 are definite options, but to consider the need for coverage of incision site, my choice would be the FICB.. and via the suprainguinal approach

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The recording of this series was not handled by us and even predated this channel…But em, thanks for the input! 😁

can view the video on shortcut sonography for ficb in this channel..

It more reliably blocks the obturator nerve: th-cam.com/video/1z90Vwcw7_A/w-d-xo.html

Can you clarify your question?

That will depend on the patient and exact location of fascia penetration. In this video the penetration was at around 1 cm. Going more proximal would mean a slightly deeper penetration as the fascia becomes deeper. As long as the LA spreads deep to the deep circumflex iliac artery and not too deep to become intramuscular the depth is appropriate.

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Um...Thanks for the comment!

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Yes it can, especially when abdominal excursion is hindered. When prone and intubated the chest is already compressed; abdominal excursion is how ventilation occurs efficiently. That is why typically support in the prone position is applied to the head, chest and pelvis (and usually the knees are slightly flexed too by supporting the leg); the abdomen is not supported to allow free movement. This needs to be checked post positioning. rc.rcjournal.com/content/respcare/60/11/1660.full.pdf academic.oup.com/bja/article/100/2/165/272685

Hi. I'll get the organizing committee to reply to this matter. Thanks

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Hi Rajan, HPKK is still processing the certificates. The QR code was the link to google form for HPKK to prepare the certificate for you. If you have scanned and filled in the google form, please wait for HPKK to issue the certificate to the email that you have submitted. Please do give them some time to process. Thanks for joining.

Me too, I haven’t receive e cert yet, i did filled up the google form,

Sorry, just noticed that the organizer's reply was held for review and thus not displayed...

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