Top Tweets for #qlblocks

over 2 years ago

"ABDOMINAL WALL BLOCKS: Check your A-Belly-T" #Abdominalwallblocks #Truncalblocks #TAPblocks #QLBlocks #MTAPAblock #TFPblock #FasciaTranversalisBlock #ShamraockSign #RSB #RectusSheathBlock My 10 Points: 1. Rectus Sheath Block (RSB): Bilateral injections are required. LA deposition – Between the posterior border of RAM-posterior rectus sheath. Landmark-guided- Needle entry medial to the Linea semilunaris. USG guided- Probe placed transversely medial to the midclavicular line. Sometimes 4 quadrants injections (2 above and 2 below the umbilicus) are required. Coverage: T6-T12 bilateral ACNs. 2. Transverse Abdominis Plane (TAP) Block: LA deposited in the myofascial plane superficial to the TAM. LA volume-0.2-0.3 ml/kg/site. Covers only dermatomal supply. Landmark-guided TAP: In the triangle of Petit posterior to the mid-axillary line above the iliac crest. A double pop technique using a blunt needle – first Pop due to penetration of EOM fascia and second due to penetration of IOM fascia. Subcostal TAP: Probe kept lateral to the xiphoid process and parallel to the costal margin. LA deposition – after 2 pops (Landmark guided) OR between RAM-TAM (medial to Linea Semilunaris) OR Between IOM-TAM (lateral to Linea Semilunaris). Coverage- T6-T8 (for inj. medial to Linea Semilunaris) or T10-T11(for inj. lateral to Linea Semilunaris). Oblique Subcostal TAP: Probe is kept obliquely between midclavicular-anterior axillary lines parallel to the costal margin. Coverage - Same as subcostal TAP and restricted up to anterior axillary line. Lateral TAP: Probe kept transversely midway between the costal margin and Iliac crest in the Midaxillary Line. Coverage- T9/T10 - T12/L1 dermatomes centered around MAL. Dual TAP: Combination of Subcostal TAP + Lateral TAP. Posterior TAP: Probe posterior to the Anterior axillary lines to cover LCNs. 3. Ilioinguinal-Iliohypogastric N. Block: Landmark-guided- Needle entry 1-2 cm medial and inferior to ASIS. After 1st Pop of EOM fascia, 6-8 ml LA is deposited to target IHN. After 2nd Pop of IOM fascia, 6-8 ml LA is deposited to target IIN. USG 2 approaches: Placing the probe medial to the ASIS over the Spino-Umbilical line. Or Placing the Probe superior and posterior to ASIS. Deep circumflex Iliac A. seen medially above TAM. 4. ThoracoAbdominal N. block through Perichondrial Approach (TAPA)/ Modified TAPA (M-TAPA): TAPA block involves 2 injections – Between IOM-TAM & EOM-Costal cartilage at 9-10th costal cartilage. The probe is placed sagitally over the 9th-10th costal cartilages at the anterior axillary line. M-TAPA is given only between IOM-TAM. Coverage- ACN > LCN of Thoracoabdominal Ns (T6/7-T11/12). 5. External Oblique Plane (EXOP) Block: It consists of 3 injections - 1 Costal & 2 Lateral. For costal injection, the Probe is placed sagitally over the 10th costal cartilage at the anterior axillary line. For lateral injections, the Probe is kept transversely cephalad to the iliac crest at the anterior axillary line and causal to the costal margin at the posterior axillary line. LA deposition – In the plane superficial to the EOM. Coverage - Blocks the LCNs of the entire abdomen (T7-T12). 6. Fascia Transversalis Block (TFP): Probe is placed over the posterior axillary lines parallel and against the iliac crest tilted caudally. LA deposition below TAM, pushing the Fascia Transversalis above the anechoic Preperitoneal Fat Layer. Coverage- T12-L1 dermatome around the iliac crest. 7. PRS/Lateral Raphe/LIFT: Thoracolumbar Fascia (TLF) is the deep fascia of the back. Its Anterior layer covers QLM anteriorly, the Middle layer covers QLM posteriorly, and the Posterior layer ESPM. The deeper lamina of the Posterior Layer is called the Paraspinal Retinacular Sheath (PRS) . The joining of middle and posterior TLF layers forms Lateral Raphae. The Lumbar InterFascial Triangle (LIFT)* is formed by the Lateral Raphe (Apex), ESPM & PRS (Base), and Middle and posterior TLF (Borders). 8. Quadratus Lumborum Blocks (QLB): Probe is kept over the Flank, near the posterior axillary line, parallel to and above the Iliac Crest. Sonoanatomy looks like a Clover-Leaf appearance (Shamrock Sign), formed by TP of the lumbar vertebra, QLM above it, PSM anterior, and ESPM posterior to it. QL 1 (Lateral QL) Block: LA deposited over the lateral aspect of QLM, lateral to the tapered end of TAM. Coverage- T7 – L1. QL 2 (Posterior QL) Block: LA deposited posteriorly between QL-ESP muscles in the LIFT. Coverage – T7- L2. QL 3 (Anterior/Transmuscular QL) Block: LA deposited anteriorly between QL-Psoas muscles. Coverage – T6 – L2. QL 4 (Intramuscular QL) Block: LA deposited inside QLM. Mechanism – Unknown, can be diffusion of LA towards the TLF involving nerves. 9. Subcostal QLB: It is another approach to anterior QLB where the Probe is kept over the posterior axillary line between the iliac crest and costal margin looking anteriorly. LA deposition – Between Psoas M. – QLM. Coverage – T6 – L2. 10. Lumbar Plexus Block (Shamrock approach): Probe placed over the Flank to identify Clover-Leaf appearance or Shamrock Sign. LA deposition- In the belly of Psoas M. after confirming Quadriceps twitches upon neurostimulation. For more details, Click Following Links:* *Formation of Rectus Sheath:* https://t.co/Guo6MqNgzo *Anterior abdominal wall muscles:* https://t.co/1CBA2CwCVy *Quadratus Lumborum Muscle:* https://t.co/tGDY55B6t4 *Subcostal QL Block:* https://t.co/Zq1jFtwgEx *How to obtain Shamrock Sign?:* https://t.co/hbSp1IkPfC *Difference between FTB and Lateral QLB:* https://t.co/cLIT4JYu1c

KartikBSonawane's tweet photo. "ABDOMINAL WALL BLOCKS: Check your A-Belly-T"

#Abdominalwallblocks #Truncalblocks #TAPblocks #QLBlocks #MTAPAblock #TFPblock #FasciaTranversalisBlock #ShamraockSign #RSB #RectusSheathBlock

My 10 Points:

1. Rectus Sheath Block (RSB):
Bilateral injections are required. LA deposition – Between the posterior border of RAM-posterior rectus sheath. Landmark-guided- Needle entry medial to the Linea semilunaris. USG guided- Probe placed transversely medial to the midclavicular line. Sometimes 4 quadrants injections (2 above and 2 below the umbilicus) are required. Coverage: T6-T12 bilateral ACNs.

2. Transverse Abdominis Plane (TAP) Block:
LA deposited in the myofascial plane superficial to the TAM. LA volume-0.2-0.3 ml/kg/site. Covers only dermatomal supply.

Landmark-guided TAP: In the triangle of Petit posterior to the mid-axillary line above the iliac crest. A double pop technique using a blunt needle – first Pop due to penetration of EOM fascia and second due to penetration of IOM fascia.

Subcostal TAP: Probe kept lateral to the xiphoid process and parallel to the costal margin. LA deposition – after 2 pops (Landmark guided) OR between RAM-TAM (medial to Linea Semilunaris) OR Between IOM-TAM (lateral to Linea Semilunaris). Coverage- T6-T8 (for inj. medial to Linea Semilunaris) or T10-T11(for inj. lateral to Linea Semilunaris).

Oblique Subcostal TAP: Probe is kept obliquely between midclavicular-anterior axillary lines parallel to the costal margin. Coverage - Same as subcostal TAP and restricted up to anterior axillary line.

Lateral TAP: Probe kept transversely midway between the costal margin and Iliac crest in the Midaxillary Line. Coverage- T9/T10 - T12/L1 dermatomes centered around MAL.

Dual TAP: Combination of Subcostal TAP + Lateral TAP.

Posterior TAP: Probe posterior to the Anterior axillary lines to cover LCNs.

3. Ilioinguinal-Iliohypogastric N. Block:
Landmark-guided- Needle entry 1-2 cm medial and inferior to ASIS. After 1st Pop of EOM fascia, 6-8 ml LA is deposited to target IHN. After 2nd Pop of IOM fascia, 6-8 ml LA is deposited to target IIN.

USG 2 approaches: Placing the probe medial to the ASIS over the Spino-Umbilical line. Or Placing the Probe superior and posterior to ASIS. Deep circumflex Iliac A. seen medially above TAM.

4. ThoracoAbdominal N. block through Perichondrial Approach (TAPA)/ Modified TAPA (M-TAPA):
TAPA block involves 2 injections – Between IOM-TAM & EOM-Costal cartilage at 9-10th costal cartilage. The probe is placed sagitally over the 9th-10th costal cartilages at the anterior axillary line. M-TAPA is given only between IOM-TAM. Coverage- ACN > LCN of Thoracoabdominal Ns (T6/7-T11/12).

5. External Oblique Plane (EXOP) Block:
It consists of 3 injections - 1 Costal & 2 Lateral. For costal injection, the Probe is placed sagitally over the 10th costal cartilage at the anterior axillary line. For lateral injections, the Probe is kept transversely cephalad to the iliac crest at the anterior axillary line and causal to the costal margin at the posterior axillary line. LA deposition – In the plane superficial to the EOM. Coverage - Blocks the LCNs of the entire abdomen (T7-T12).

6. Fascia Transversalis Block (TFP):
Probe is placed over the posterior axillary lines parallel and against the iliac crest tilted caudally. LA deposition below TAM, pushing the Fascia Transversalis above the anechoic Preperitoneal Fat Layer. Coverage- T12-L1 dermatome around the iliac crest.

7. PRS/Lateral Raphe/LIFT:
Thoracolumbar Fascia (TLF) is the deep fascia of the back. Its Anterior layer covers QLM anteriorly, the Middle layer covers QLM posteriorly, and the Posterior layer ESPM. The deeper lamina of the Posterior Layer is called the Paraspinal Retinacular Sheath (PRS) . The joining of middle and posterior TLF layers forms Lateral Raphae. The Lumbar InterFascial Triangle (LIFT)* is formed by the Lateral Raphe (Apex), ESPM & PRS (Base), and Middle and posterior TLF (Borders).

8. Quadratus Lumborum Blocks (QLB):
Probe is kept over the Flank, near the posterior axillary line, parallel to and above the Iliac Crest. Sonoanatomy looks like a Clover-Leaf appearance (Shamrock Sign), formed by TP of the lumbar vertebra, QLM above it, PSM anterior, and ESPM posterior to it.

QL 1 (Lateral QL) Block: LA deposited over the lateral aspect of QLM, lateral to the tapered end of TAM. Coverage- T7 – L1.

QL 2 (Posterior QL) Block: LA deposited posteriorly between QL-ESP muscles in the LIFT. Coverage – T7- L2.

QL 3 (Anterior/Transmuscular QL) Block: LA deposited anteriorly between QL-Psoas muscles. Coverage – T6 – L2.

QL 4 (Intramuscular QL) Block: LA deposited inside QLM. Mechanism – Unknown, can be diffusion of LA towards the TLF involving nerves.

9. Subcostal QLB:
It is another approach to anterior QLB where the Probe is kept over the posterior axillary line between the iliac crest and costal margin looking anteriorly. LA deposition – Between Psoas M. – QLM. Coverage – T6 – L2.

10. Lumbar Plexus Block (Shamrock approach):
Probe placed over the Flank to identify Clover-Leaf appearance or Shamrock Sign. LA deposition- In the belly of Psoas M. after confirming Quadriceps twitches upon neurostimulation.

For more details, Click Following Links:*

*Formation of Rectus Sheath:*
https://t.co/Guo6MqNgzo

*Anterior abdominal wall muscles:*
https://t.co/1CBA2CwCVy

*Quadratus Lumborum Muscle:*
https://t.co/tGDY55B6t4

*Subcostal QL Block:*
https://t.co/Zq1jFtwgEx

*How to obtain Shamrock Sign?:*

https://t.co/hbSp1IkPfC

*Difference between FTB and Lateral QLB:*

https://t.co/cLIT4JYu1c

Dr Amit Pawa💉🎙️ @amit_pawa

about 10 years ago

@elboghdadly @KiJinnChin @RAPMOnline this is a really important point and will clear up the confusion in 1/2/3 nomenclature! #QLBlocks

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