title: Quadratus lumborum block for femoral-femoral bypass graft placement: A case report.
abstract: BACKGROUND
  Atherosclerosis has a complex etiology that leads to arterial obstruction and often results in inadequate perfusion of the distal limbs. Patients with atherosclerosis can have severe complications of this condition, with widespread systemic manifestations, and the operations undertaken are often challenging for anesthesiologists.
  
  
  METHODS
  A 79-year-old woman with chronic heart failure and respiratory dysfunction presented with bilateral gangrene of the distal lower extremities with obstruction of the left common iliac artery due to atherosclerosis. Femoral-femoral bypass graft and bilateral foot amputations were planned. Spinal anesthesia failed due to severe scoliosis and deformed vertebrae. General anesthesia was induced after performing multiple nerve blocks including quadratus lumborum, sciatic nerve, femoral nerve, lateral femoral cutaneous nerve, and obturator nerve blocks. However, general anesthesia was abandoned because of deterioration in systemic perfusion. The surgery was completed; the patient remained comfortable and awake without the need for further analgesics.
  
  
  CONCLUSIONS
  Quadratus lumborum block may be a useful anesthetic technique to perform femoral-femoral bypass.
authors: Department of Anesthesiology, Kyorin University School of Medicine, Shinkawa, Mitaka-shi, Tokyo Department of Surgery, Jichi Medical University, Yakushiji, Shimotsuke-shi, Tochigi-ken, Japan.
authors: Kunitaro
authors: K
authors: Watanabe
authors: Shingo
authors: S
authors: Mitsuda
authors: Joho
authors: J
authors: Tokumine
authors: Alan Kawarai
authors: AK
authors: Lefor
authors: Kumi
authors: K
authors: Moriyama
authors: Tomoko
authors: T
authors: Yorozu
mesh_terms: D000009:Abdominal Muscles; D000368:Aged; D000671:Amputation, Surgical; D000768:Anesthesia, General / Q000009:adverse effects; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005267:Femoral Nerve; D005528:Foot / Q000601:surgery; D006801:Humans; D009407:Nerve Block / Q000379:methods*; D009776:Obturator Nerve; D058017:Vascular Grafting