Top Tweets for #PosteriorQLB

9 months ago

🚀 “Fascial Highways, Not Magic Shots” - Take-Home Messages from Decoding QL Blocks #RegionalAnesthesia #PainMedicine #UltrasoundGuided #FascialPlaneBlocks #QuadratusLumborumBlock #QLB #ThoracolumbarFascia #TLF #TransmuscularQLB #AnteriorQLB #PosteriorQLB #TAPBlock #AbdominalWallAnalgesia 🧭 QLB is TAP’s evolved cousin: TAP mainly stays in the TAP plane (somatic abdominal wall), while QLB tries to “borrow” deeper fascial continuities to extend coverage. 🕸️ The thoracolumbar fascia (TLF) is the real engine: QLB success is governed more by fascial architecture than by “which nerve you think you’re blocking.” 🛣️ Anterior TLF = the main ‘fascial highway’: It connects laterally to transversalis fascia, medially to psoas fascia, and cranially toward endothoracic fascia- explaining why deeper approaches can sometimes go broader (and occasionally visceral). 🎯 If you want broader + more predictable spread, think “anterior/transmuscular”: The review highlights why anterior approaches more consistently access paravertebral/lumbar plexus corridors than superficial/lateral techniques. 🧱 Lateral & posterior QLB = reliable somatic analgesia (mostly): Great for flank/lateral wall pain, but don’t expect consistent visceral cover. 🔬 T12→L1 transition is the clinical ‘game-changer’: At/after L1, the psoas is more evident and the lumbar plexus starts forming- helping explain why anterior QLB at/below L1 can be more extensive. 🧠 Stop teaching the wrong nerve story: Lumbar plexus nerves don’t just “enter the TAP.” That common schematic error leads to unrealistic expectations from TAP/lateral QLB. 🧩 Anterior QLB isn’t one block-it’s multiple sub-compartments: Small needle-tip shifts can redirect spread cranial/medial/posterior and change what you get clinically. 🔼 Want upper abdominal + possible visceral component? Aim for the plane that favors cranial tracking along endothoracic continuity (subcostal/anterior variants are built for this logic). 🧷 Technique selection should be indication-driven: Lateral/posterior for somatic flank; anterior/CPPB when you need deeper/lumbar plexus or broader abdominal–pelvic coverage. ⚠️ Safety isn’t optional - anterior is closer to neuraxis/lumbar plexus: Higher risk of unintended neuraxial spread if volume/plane is wrong; lateral variants risk peritoneal/retroperitoneal breach, so dynamic US, incremental injection, and vigilance matter. 📌 Bottom line: QLB outcomes vary because anatomy + fascial compliance + injection dynamics vary - so reproducibility comes from precise plane selection, not from “QLB label” alone. Read in details: Indian Journal of Anaesthesia https://t.co/CHRCwW6HR0

KartikBSonawane's tweet photo. 🚀 “Fascial Highways, Not Magic Shots” - Take-Home Messages from Decoding QL Blocks

#RegionalAnesthesia #PainMedicine #UltrasoundGuided #FascialPlaneBlocks #QuadratusLumborumBlock #QLB #ThoracolumbarFascia #TLF #TransmuscularQLB #AnteriorQLB #PosteriorQLB #TAPBlock #AbdominalWallAnalgesia

🧭 QLB is TAP’s evolved cousin:
TAP mainly stays in the TAP plane (somatic abdominal wall), while QLB tries to “borrow” deeper fascial continuities to extend coverage.

🕸️ The thoracolumbar fascia (TLF) is the real engine:
QLB success is governed more by fascial architecture than by “which nerve you think you’re blocking.”

🛣️ Anterior TLF = the main ‘fascial highway’:
It connects laterally to transversalis fascia, medially to psoas fascia, and cranially toward endothoracic fascia- explaining why deeper approaches can sometimes go broader (and occasionally visceral).

🎯 If you want broader + more predictable spread, think “anterior/transmuscular”:
The review highlights why anterior approaches more consistently access paravertebral/lumbar plexus corridors than superficial/lateral techniques.

🧱 Lateral & posterior QLB = reliable somatic analgesia (mostly):
Great for flank/lateral wall pain, but don’t expect consistent visceral cover.

🔬 T12→L1 transition is the clinical ‘game-changer’:
At/after L1, the psoas is more evident and the lumbar plexus starts forming- helping explain why anterior QLB at/below L1 can be more extensive.

🧠 Stop teaching the wrong nerve story:
Lumbar plexus nerves don’t just “enter the TAP.” That common schematic error leads to unrealistic expectations from TAP/lateral QLB.

🧩 Anterior QLB isn’t one block-it’s multiple sub-compartments: Small needle-tip shifts can redirect spread cranial/medial/posterior and change what you get clinically.

🔼 Want upper abdominal + possible visceral component?
Aim for the plane that favors cranial tracking along endothoracic continuity (subcostal/anterior variants are built for this logic).

🧷 Technique selection should be indication-driven:
Lateral/posterior for somatic flank; anterior/CPPB when you need deeper/lumbar plexus or broader abdominal–pelvic coverage.

⚠️ Safety isn’t optional - anterior is closer to neuraxis/lumbar plexus:
Higher risk of unintended neuraxial spread if volume/plane is wrong; lateral variants risk peritoneal/retroperitoneal breach, so dynamic US, incremental injection, and vigilance matter.

📌 Bottom line:
QLB outcomes vary because anatomy + fascial compliance + injection dynamics vary - so reproducibility comes from precise plane selection, not from “QLB label” alone.

Read in details:
Indian Journal of Anaesthesia https://t.co/CHRCwW6HR0

Dr Amit Pawa💉🎙️ @amit_pawa

over 7 years ago

@LSORA_UK #PosteriorQLB

Dr Amit Pawa💉🎙️ @amit_pawa

about 9 years ago

@AmoScanner @boynebellew @KiJinnChin @918sleeper @loki1706 @LloydTurbitt @dr_tgro @pjbose @IcostacheIoana I was totally confused by your tweet amoscanner! I have stopped PVBs for Mastectomy in DIEPS. I use #QLB2 #PosteriorQLB

Dr Amit Pawa💉🎙️ @amit_pawa

about 9 years ago

@ESchwenkMD @ASRA_Society My sole RA technique for abdominal incision for DIEP flaps is #QLB2 #PosteriorQLB as part of balanced anaesthesia- gr8 results...

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