A description of an ultrasound-guided technique for a quadratus lumborum block in the cat: a cadaver study.

Abstract

OBJECTIVES: To describe the ultrasonographic (US) anatomy of the sublumbar region at the level of second lumbar vertebra (L2), to assess the feasibility of US-guided quadratus lumborum (QL) injections and to evaluate the dye distribution pattern in feline cadavers. STUDY DESIGN: Descriptive feline cadaver study. ANIMALS: A total of eight cat cadavers. METHODS: Using a linear probe (6-14 MHz), with the cadavers in lateral recumbency, the QL and psoas muscles (Pm) were identified at the level of L2 and landmarks recorded. Using an in-plane technique, a spinal needle was inserted in a ventrodorsal direction to reach the interfascial plane between the QL and Pm. Using a ropivacaine, dye and iohexol solution, a total volume of 0.4 mL kgwas injected. Computed tomography (CT) scanning and anatomic dissection were performed to evaluate the spread of injectate. Presence of dye on the sympathetic trunk was compared between assessment methods using kappa coefficient of agreement (κ). RESULTS: Using US guidance, the QL-Pm interfascial plane was identified and dye solution was present in the target fascial plane in all animals. Injectate was distributed on the ventral roots of the spinal nerves between the first and third lumbar vertebrae in 6/8 cats, and on the sympathetic trunk from the thirteenth thoracic to the third lumbar vertebrae in 7/8. Dye was found on the major splanchnic nerve in 7/8 cats and on the minor splanchnic nerve and coeliac ganglion pathways in all animals. Agreement between dissection and CT images dye distribution on the sympathetic trunk was κ = 0.72. CONCLUSIONS AND CLINICAL RELEVANCE: The US-guided QL injection was feasible and injectate was present in the QL-Pm interfascial plane in all feline cadavers. In vivo studies are warranted to evaluate the analgesic efficacy of this technique for abdominal surgical procedures.