Quadratus lumborum block in management of severe pain after uterine artery embolization

Bruce Ben-David, Z. Kaligozhin, Dmitriy Viderman

2018

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DOI 10.1002/ejp.1171
Data confidence 70 medium
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Abstract

BACKGROUND AND OBJECTIVES: The quadratus lumborum (QL) block has been widely used for acute postoperative pain management after numerous surgical procedures including urological, abdominal, gynaecological and orthopaedic surgical procedures. The local anaesthetic spread in this area can provide unilateral sensory block in T6-L2 dermatomes. We performed bilateral quadratus lumborum block for the management of acute pain after the uterine artery embolization (UAE). METHODS: A 43-year-old woman was admitted to the gynaecology department of Mother and Child Hospital, University Medical Center, for uterine artery embolization. Shortly, after successful completion of the UAE procedure, the patient began to complain of severe pain in the lower abdomen rated as a 9 on a verbal analogue scale (VAS) of 0-10. Intravenous tramadol 100 mg was infused over 30 min with minimal reduction in pain. Trimeperidine 20 mg was then infused over 30 min. Pain scores, however, remained 7-8/10 on the VAS. It was therefore decided to place a bilateral single-shot ultrasound-guided quadratus lumborum block. RESULTS: The procedure was well tolerated and brought notable pain relief. VAS declined from 8/10 to 5/10 after 30 min and to 3/10 at 60 min. Over the ensuing 24 h, VAS pain intensity remained 2-3/10. No further analgesics were necessary. CONCLUSION: A randomized control clinical trial is warranted to assess the efficacy of QL blockade and to compare it with other analgesic options in uterine artery embolization. Bilateral quadratus lumborum blockade may be an excellent pain control option after uterine artery embolization. SIGNIFICANCE: Uterine artery embolization is associated with significant postprocedural pain which can prove difficult to manage with opioids. Bilateral quadratus lumborum block may be an excellent pain control option - one that might significantly reduce not only pain, but also the need for opioids and perhaps even the need for hospitalization.