6–8 Therefore, anterior QL block allows the LA to diffuse cranially via the arcuate ligaments and DAZ, and into the subendothoracic fascia compartment. 4, 6 The transversalis fascia divides into upper and lower leaflets when it approaches medial and lateral arcuate ligament, and the upper leaflet, also known as endothoracic fascia, covers the inferior surface of the diaphragm in the diaphragmatic apposition zone (DAZ). 4, 5 The former involves the local anesthetic (LA) injection between QL and psoas muscle, and the latter targets the LA into the potential compartment between the QL and transversalis fascia at L1-2 level. 1–3 The anterior QL block includes two subtypes, the transmuscular and subcostal QL blocks. It has been reported that the anterior quadratus lumborum (QL) block provides effective postoperative analgesia in laparoscopic nephrectomy. Keywords: diaphragmatic apposition zone, laparoscopy, nephrectomy, sensory block, postoperative analgesia It provides a new postoperative analgesia option for patients undergoing laparoscopic nephrectomy. Total dose of intravenous morphine equivalent consumption in the first 24 h after surgery was 21.2 ± 4.1 mg.Ĭonclusion: The DAZ block manifests a wide dermatomal coverage of sensory loss and is associated with the low levels of postoperative pain intensity and opioid use. The muscle strength of the quadriceps femoris evaluated was 5 (5– 5) points. The postoperative pain scores at rest or on movement at 2 h, 6 h, 12 h, 24 h and 48 h were kept at the low levels (less than 4). The highest level of sensory loss was T6 (T5-T6), and the lowest level of sensory block was L1 (L1–L2). Results: The average number of dermatomes of sensory block was 8.6 ± 1.2. The opioid consumption in the first 24 h after surgery was recorded. The dermatomes of sensory loss and the muscle weakness of quadriceps femoris were assessed at 2 h post-surgery in the wards. All patients received the intravenous patient-controlled analgesia after surgery. The DAZ blocks were performed in patients under direct laparoscopic visualization with 20 mL of 0.5% ropivacaine before the dissected kidneys or renal tumors were taken out from the incision. Methods: A total of 28 patients scheduled to receive elective laparoscopic nephrectomy under general anesthesia were enrolled in this study. Therefore, we evaluated the sensory loss and postoperative analgesic efficacy of this new block in patients receiving laparoscopic nephrectomy. Therefore, a new block may be achieved if local anesthetic is administered into the diaphragmatic apposition zone (DAZ) under direct laparoscopic visualization by surgeons. Purpose: Local anesthetics can spread into the subendothoracic fascia compartment via the arcuate ligament and apposition zone of the diaphragm after the anterior quadratus lumborum blocks. *These authors contributed equally to this workĬorrespondence: Yun Wang, Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, No. Rong Shi, 1, * Mingshuai Wang, 2, * Xiaoyong Yang, 2 Peiqi Shao, 1 Jinghan Liang, 1 Yun Wang 1ġDepartment of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China 2Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
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