Top Tweets for #QLBlock
TAP or Trap? - Rethinking the True Territory of the Transversus Abdominis Plane Block
#BeyondTAP #AbdominalAnalgesia #RegionalAnesthesia #TAPBlock #QuadratusLumborum #QLBlock #EOIP #FascialPlaneBlocks #PainManagement #UGRA #AcutePain #AnatomyMatters #BlockSmart #SomaticVsVisceral #KnowBeforeYouBlock
#MyRATips #TipOfTheDay
Tip of the Day:
โจ The Transversus Abdominis Plane (TAP) block is often perceived as a comprehensive abdominal wall block.
โจ Anatomically and clinically, however, its coverage is selective, variable, and frequently incomplete. Letโs decode it logically.
๐ง Segmental - Not Complete Dermatomal Coverage
๐น Targets anterior rami of T6โL1 within the fascial plane
๐น Spread is plane-dependent and inconsistent
๐น Neural branching forms a TAP plexus โ dermatomal predictability drops
๐น Upper abdominal coverage (T6โT9) is unreliable
โก๏ธ Reality: Partial somatic sensory block - not uniform dermatomal anesthesia.
๐งฉ Medial Sparing - The Rectus Sheath Gap
๐น Anterior Cutaneous Nerves (ACNs) pierce the posterior rectus sheath
๐น TAP does not reliably block ACNs
๐น Midline analgesia requires Rectus Sheath Block
๐น โMedial escape zoneโ phenomenon
โก๏ธ Reality : Without RSB, central abdominal wall remains inadequately covered.
โก Lateral Cutaneous Nerve Escape
๐น Lateral cutaneous branches exit early from the neurovascular plane
๐น Standard lateral TAP frequently spares them
๐น Posterior TAP improves but does not guarantee coverage
โก๏ธ Reality : Lateral abdominal wall analgesia may be incomplete.
๐ช Muscle Innervation Overlap - No True Motor Promise
๐น Abdominal wall muscles have overlapping segmental innervation
๐น Blocking selected segments โ muscle paralysis
๐น TAP is primarily sensory
โก๏ธ Reality: It is not a muscle relaxation technique.
๐ฅ No Visceral Analgesia
๐น Blocks somatic afferents only
๐น Visceral pain travels via sympathetic & splanchnic pathways
๐น Peritoneal stretch & bowel manipulation remain untouched
โก๏ธ Reality: Not adequate as a standalone block for intra-abdominal surgery.
๐ค So Why Consider TAP at All?
Because it still has value, when chosen rationally.
โ
Superficial abdominal wall procedures
โ
Part of multimodal analgesia
โ
When neuraxial is contraindicated
โ
To reduce opioid requirement
โ
When combined strategically (RSB + posterior TAP)
๐ฏ Decision Lens
๐น Lower abdominal superficial โ TAP acceptable
๐น Upper abdominal โ EOIP preferred
๐น Mixed somatic + visceral โ QL more rational
๐น Major open abdominal โ Epidural still gold standard
๐ Take-Home
โจ TAP is not wrong - it is simply limited.
โจ It is a plane block, not a pan-abdominal solution.
โจ Choose based on pain source: somatic vs visceral vs mixed.
โ๐ฆด From Skin to Capsule: Smart Blocks for Every Hip Cut!โ
#THR #RegionalAnesthesia #PENGblock #FICB #QLblock #TAPblock #LFCNblock #SmartAnalgesia #PostOpPain #OrthoAnesthesia
#TipoftheDay
#MyRATips
Tip of the Day:
The key to Post-op analgesia after Total Hip Replacement?
Block what mattersโbased on Surgical approach & Innervation.
โถ๏ธ Anterior Approach
๐น Joint Capsule (Anterior)
โ Use PENG block (targets FN, ON, AON)
๐น Skin โ Upper Incision
โ Subcostal (T12), Iliohypogastric (L1)
โ Add TAP (subcostal/lateral) or QL block (Type 1/2)
๐น Skin โ Mid/Lower Incision
โ IIN, GFN, LFCN โ Block with FICB, TFP, or LFCN block
โถ๏ธ Anterolateral Approach
๐น Joint Capsule (Anterior & Lateral)
โ Covered well by PENG block
๐น Skin
โ Mostly LFCN, ยฑ IIN/GFN
โ Use FICB or LFCN block
โ If upper extension โ add TAP/QL
โถ๏ธ Posterolateral Approach
๐น Joint Capsule (Posterior)
โ Minimally nociceptive โ No sciatic block needed
โ Use PENG for anterior capsule
๐น Skin โ Upper Incision
โ T12, L1 (Subcostal, IHG) โ TAP/QL block
๐น Skin โ Lower Incision
โ LFCN โ Use LFCN block or high-volume FICB
โถ๏ธ Local Anesthetic Strategy
๐งช Type:
Ropivacaine 0.2โ0.25%, Bupivacaine 0.125โ0.25%
๐ Volumes:
โ PENG: 20 mL
โ FICB: 30โ40 mL
โ TAP/QL: 20โ30 mL
โ LFCN: 5โ10 mL
My go-to hierarchy for THR analgesia:
QLB > FICB > PENG + LFCN
"Block smart.
Incision-specific.
Capsule-aware.
Approach-adapted."
"๐ฏ Cracking the QL Code: Cross-Sectional Secrets Unlocked! ๐ฉบโจ"
#RegionalAnesthesia #UltrasoundTips #AnatomyInsights #QLBlock #PainManagement #TipOfTheDay #MyRATips
๐ฉบ Tip of the Day:
โ
Cross-sectional Anatomy (T12-L1): Essential for accurate QL blocks!
๐ธ At T12 Level:
๐ฌ๏ธ Prominent muscle: Diaphragm
๐ซ QL & Psoas muscles minimally visible or absent
๐ Subcostal nerve (T12) courses anterior to QL muscle
๐ธ At Lumbar Level (L1 onwards):
๐ช Prominent muscles: Quadratus Lumborum & Psoas Major
๐ Lumbar plexus forms within the Psoas Major Muscle
โ๏ธ Plexus nerves exit laterally, crossing anteriorly over QL muscle
๐จ Lumbar nerves do not enter TAP plane (already occupied by TAP plexusโthoracoabdominal nerves)
โจ Only Iliohypogastric & Ilioinguinal nerves briefly enter TAP plane at ASIS level before becoming cutaneous
๐ Clinical Pearl:
๐ Precise neural pathway knowledge is vitalโmany textbooks inaccurately depict these anatomical routes. Correct understanding is crucial for mastering QL block mechanics and ensuring successful nerve blocks!
For more details, read the following article:
https://t.co/2pLjnRO5Kq
https://t.co/Nc3uXni32j
"๐พ๐ง๐๐๐ ๐๐ฃ๐ ๐ฉ๐๐ ๐๐ ๐พ๐ค๐๐: ๐๐ฅ๐ค๐ฉ ๐ฉ๐๐ ๐๐๐จ๐ฉ๐๐ ๐ ๐๐ฃ ๐ฝ๐ก๐ค๐๐ ๐ผ๐ฃ๐๐ฉ๐ค๐ข๐ฎ!"
#Solvemypuzzle
#AnatomyChallenge #RegionalAnesthesia #QLBlock #MedicalPuzzle #FigureFlaw
๐งฉ Dive into the intricate world of quadratus lumborum (QL) blocks.
Can you decode what makes this block so effective?
๐ง Spot what's wrong in this attached figure and many similar images across various articles!
When youโre teaching yourself a new fascial plane block and you FINALLY get good sonoanatomy, you press the record button! #regionalanesthesia #QLblock #lifelonglearning #MedEd #MedTwitter
What is your take on QLblock..?
Does it really work..?
Which one 1/2/3 or 4..?
How much & what LA..? #RAlovers #Blockers #Anaesthesia #QLblock @AoraIndia @ESRA_Society
See this Instagram post by @saaccacademy https://t.co/Ktc66P1W3N
**Faculty Spotlight**
Dr Suwimon Tangwiwat, Secretary of @aosra_pm
Listen and interact with her on
Date - 30th September
Hall - A
Time- 11:45 - 12:00 PM
She will speak on "Quadratus lumborum plane block - Why we have different approaches"
#aoraaosra22
#RAIndia
#QLBlock
Request all @AoraIndia fellows to read this excellent review on #QLblock by @kaohesham and @elboghdadly
https://t.co/PcQUCkReIf
Reply with your queries, insights and experiences (with videos if possible)
#aorafp @ponde_vrushali
@DrRiteshRoy1
@anesthetix @DrDiveshArora
Zero postoperative pain D0,D1 and discharge home D3 via #QLblock catheter infusion for retroperitoneal CI aneurism with @LuisNav23662880 โฆpatient permission taken ..#regionalAnaesthesia
Successful Right Common Iliac Aneurysm open repair via retroperitoneal approach.
The comparison of quadratus lumborum block and caudal block for postoperative analgesia in children undergoing inguinal hernia repair and orchiopexy surgeries. QLB was more effective.
@GozenOksuz @ESchwenkMD @dr_rajgupta
#QLBlock #pedspain
https://t.co/UhpnFSk6SU
Anterior quadratus lumborum block analgesia for total hip arthroplasty. "QL block provided effective analgesia & decreased opioid requirements up to 48โhours after primary THA"
@mail2vincechan @KalagaraHari @dr_rajgupta @ESchwenkMD
#THA #QLblock #USRA
https://t.co/MBXf1tTuXx
@CandraBassMD Wonderful time hosting a #truncalblock workshop for my group @MEDNAX:American Anesthesiology of NC @WakeMed with @Pacira. Dynamic speaker @HoltzMaggie guided us through didactics and hands-on learning #exparel #regionalanesthesia #QLblock #ESB #opioidminimization
anyone used #TAPblock #QLblock 4 pain after lithotripsy as in this trial https://t.co/QxM3bEfctf
(once hematoma + colic from fragments ruled out of course)
@nelkassabany @kaohesham @amit_pawa @docmorne @PeterMerjavy @NaveenEipe @jan1boublik @KiJinnChin @ChrisPrabhakar
@dr_tgro @kaohesham @barringtonmj I hope it clarifies some concepts, provides food for thought, and increases accessibility of this useful technique! #QLBlock
https://t.co/tRDkCrS1Ud
Quadratus Lumborum Block:Anatomical Concepts, Mechanisms, and Techniques | Anesthesiology | ASA Publications โฆ@ASALifelineโฉ #QLBlock #regionalanaesthesia #postoppain https://t.co/8l2XPcoKHm
Sunday morning regional anesthesia fun w/@jeffgadsden. Thanks for visiting us at Northside Jeff! #meded #QLblock #lifelonglearning #regionalanesthesia @NorthsideHosp
@dr_tgro @nelkassabany @EMARIANOMD @lipidguy @LloydTurbitt @ASRA_Society @ESRA_Society @LSORA_UK @amit_pawa @ESchwenkMD @JensBorglum @KiJinnChin @UFMedicine Way too logical. We need something less clear like STAR1 STAR2 and STAR3. #QLblock #QuadratusLumborum #QL123joke
@iceman_ex @ESchwenkMD @doximity Agree with everyone to an extent! More studies with #ESPblock #QLblock vs. #epidural. Still very nice to have options beyond an epidural
If ur going to learn #QLblock, this is the guy to ask. Dr. Elsharkawy dropping QL pearls at #ASRASpring17
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