title: Bilateral Continuous Quadratus Lumborum Block for Acute Postoperative Abdominal Pain as a Rescue After Opioid-Induced Respiratory Depression.
abstract: We present a case of acute postoperative abdominal pain after proctosigmoidectomy and colorectal anastomosis that was treated by bilateral continuous quadratus lumborum block. The block was performed in the lateral position under ultrasound guidance with a 15-mL bolus of 0.5% bupivacaine injected anterior to the quadratus lumborum muscle followed by bilateral catheter placement. Each catheter received a continuous infusion of 0.1% bupivacaine at 8 mL/h and an on-demand bolus 5 mL every 30 minutes. Sensory level was confirmed by insensitivity to cold from T7 through T12. The block was devoid of hemodynamic side effects or motor weakness. This case demonstrates that bilateral continuous quadratus lumborum catheters can provide extended postoperative pain control.
authors.affiliation: From the Departments of *General Anesthesia, †Pain Management, and ‡Outcomes Research, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shaaban
authors.forename: Wael Ali Sakr
authors.initials: WA
authors.lastname: Esa
authors.forename: Kamal
authors.initials: K
authors.lastname: Maheshwari
authors.forename: Hesham
authors.initials: H
authors.lastname: Elsharkawy
authors.forename: Loran Mounir
authors.initials: LM
authors.lastname: Soliman
mesh_terms: D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000601:surgery; D012004:Rectal Neoplasms / Q000601:surgery; D012131:Respiratory Insufficiency / Q000139:chemically induced* / Q000188:drug therapy; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000701:Analgesics, Opioid; D002045:Bupivacaine