7/25/2019 Quadratus Lumborum Block vs Tap Block

http://slidepdf.com/reader/full/quadratus-lumborum-block-vs-tap-block 1/9

QUADRATUS LUMBORUM BLOCK vs TAP BLOCK I don't have a big expe ien!e o" QLB# B$t% I have given it in "e& patients ()*(+, e!ent-.# B$t% I "e-t that /. patients &ith TAP have bette pain e-ie" as!o/pa ed to QLB# I have $sed it in 0e nia% -apa oto/. and ena- t ansp-ant

e!ipients# It is too s/a-- n$/be to !o/pa e the things# B$t% I &i-- -i1e to1no& othe /e/be s expe ien!e#

Piyush Mallick I thin1 QLB /ight have bette es$-t

Piyush Mallick 2spe!ia--. in!ision above the $/bi-i!$sPiyush Mallick QLB p obab-. have -onge e3e!t 4 I" +5 /-6 side getsin7-t atedAhmad Samir Alabd I thin1 i /a. be e-ated to the &a. to do QLB####it issti-- a big /.st .

Piyush Mallick I thin1 Ah/ad is ight #### So /an. app oa!hes to QLB(%+%8 then t ans/$s!$-a 4

9eeds to be standa di:edTushar Dixit I have t ied this b-o!1 5*; ti/es# Ma. be ha-" o" the ti/e I "e-t I&as in the ight p-a!e and the othe ha-" I !hi!1ened o$t and gave poste io

TAP# <e need "e& videos on the "o $/ o" peop-e doing QL b-o!1s and then &e!an a-- disse!t the/ and s$ggest the best app oa!hHetal Vadera One I gave at 0.de abad &o 1shop $nde g$idan!e o" ShivK$/a Singhsi &as &ith satis"a!to . pain e-ie"#

Hetal Vadera =i>a. K Sha /a %Can .o$ p-ease post it on g o$p?Vijay Kr Sharma Si % that patient &as posted "o -apa oto/. "o so/es!h&ano/a% and post ope ative patient had good pain e-ieve% even his =ASs!o es &e e a-so -ess#

Ashar Hasan Kind-. post## b-ind app oa!h as &e--% "o pp- not having $sg"a!i-it.Shiv Kumar Singh Than1 @o$ 0eta- o This Post#

Li1e An.thing% The e A e Li/itations To This B-o!1s#Man. <i-- Sa. It <o 1s% O$t o" ashion# The T $th <i-- 9ot Co/e O$t In TheOpen Be!a$se o" P$b-i!ation Bias# <e 0ave Seen This <ith TAP B-o!1s oRena- T ansp-ants# The. Do <o 1 BUT not in A--# In one o-d /an it &o 1edeven &ith Sa-ine% =AS o" 2RO in the post*op pe iod#

Thin1 Logi!a--.% <h. QLB (% + and The/ 84 Obvio$s-. P evio$s Ones Did 9ot<o 1 and <e Kno& It o/ A en$ine So$ !e#

7/25/2019 Quadratus Lumborum Block vs Tap Block

http://slidepdf.com/reader/full/quadratus-lumborum-block-vs-tap-block 2/9

I S$ppo t @o$ Obse vations and I Can P ove The/ Anato/i!a--. andS!ienti7!a--.4Vsevolod ykhin https 66.o$t$#be6a5OSUE:t9ng

Ta1eshi

P esenta!iFn sob e B-oE$eo de- C$ad ado L$/ba % a !a go de- D # Ta1eshiG @OUTUB2#COMShiv Kumar Singh QL B-o!1 Is B-o!1 o" T(+ and L( and Anato/i!a--. andLogi!a--.% It Can not b-o!1 an.thing e-se#

The M$s!-e Itse-" Is S$pp-ied B. T(+ and The (st H L$/ba 9e ves#

Both T(+ and L( Lie Ante io To The Q$ad ates L$/bo $/ and Then Pie !e The T ansve s$s Abdo/ens M$s!-e To Lie In The TA P-ane#

<e A-- Kno& That L+%8%H and 5 Lie In Psoas Co/pa t/ent and Cannot BeB-o!1ed <ith QLB An Advantage,#

The M$s!-e Lie In C-ose Re-ation To The Kidne.s% The. Lie Ante io To TheM$s!-e and Sa.ing That It Is A Sa"e B-o!1 <o$-d Be =e . < ong#

<e 0ave Dis!$ssed This In Detai-s% The e A e () di3e ent =a iations in II9and I09 T(+ and L(, and 0en!e Man. A Ti/es 2ven <ith ood B-o!1% @o$<i-- ai-#

It Is =e . 2as. To Do P9S $ided T(+6L( P=B and I Do It A-- The Ti/e o

T0Rs and 0e/i a-ong <ith LPB and SPB#

Shiv Kumar Singh See This I/age Ah/ad 4

7/25/2019 Quadratus Lumborum Block vs Tap Block

http://slidepdf.com/reader/full/quadratus-lumborum-block-vs-tap-block 3/9

Ahmad Samir Alabd D #Shiv###&hat abo$t pa ave t# B-o!1 at T()*((*(+*L(###!o$-d that ep-a!e TAP?Mehdi Hassan &hat is the di3e en!e bet&een T ansve sa-is as!ia P-aneb-o!1% Post TAP QLD# &hat -eve- o" ana-gesia !an be a!hieve b. the/?Mehdi Hassan no& I >$st do s!an and I thin1 its eas. to have QLD &ith

-inea p obe -oo1s big , than !$ vi-inea # expe t opinion P-:Shiv Kumar Singh @es Ah/ad % The. Can o Lo&e Abdo/ina- S$ ge .#

The e A e Man. Pape s on Use o" L( P=B "o 0e nia S$ ge .#

Mehdi Ant to Post o Dista- To P oxi/a- B-o!1J TAP** Post TAP*** T ansve sa-is as!ia B-o!1 ** QLB *** P=B4

Depositing LA Post To QL <i-- 9ot <o 1 and I" It 0as To Then LA 9eed to T ave- Late a--. so that it ea!hes the Late a- Bo de o" QL o @o$ In>e!t LA onit Late a- Side that &o$-d /a1e it T B a-/ost,4

Ahmad Samir Alabd Thanx a -ot d #Shiv#

Shiv Kumar Singh Pi.$sh % Above The U/bi-i!$s Is T; to T() and The e is9o <a. That QL <hi!h Inse ts into (+th Rib and !ove ed &ith Tho a!odo sa-

as!ia <i-- A--o& LA to Sp ead P oxi/a--. to T; *T() Leve-4Tushar Dixit D$ ing ARA% D Deep A o a !onvin!ing exp-ained s$!!ess"$-t ans/as!$-a QLB "o ena- s$ ge .# 0o& !an &e exp-ain s$!h a !onsistante3e!tShiv Kumar Singh I" .o$ -oo1 at the In!ision "o Rena- T ansp-ants it is in

T(+ L( te ito . and hen!e .o$ &i-- get good ana-gesia# It is on-. b.

!ond$!ting an RCT .o$ &i-- 1no& i" it is t $-. e3e!tive as happened &ith $s&ith TAP B-o!1s#Ahmad Samir Alabd

Shiv Kumar Singh I Thin1 That I/age Is 9ot A!!$ ate Ah/ad % 9one o" The9e ves T ave- Th o$gh The Q$ad at$s L$/bo $/ M$s!-e#

The e A e On-. T<O 9e ves That Lie In Di e!t Re-ation To The M$s!-e and That A e T(+ and L(% Both Lie On Ante io S$ "a!e O" The M$s!-e#

7/25/2019 Quadratus Lumborum Block vs Tap Block

http://slidepdf.com/reader/full/quadratus-lumborum-block-vs-tap-block 4/9

Ahmad Samir Alabd That is &hat &as !o"$sing /e abo$t this b-o!1d #Shiv###a-so those &ho !-ai/ $sing it e-. on this diag a/####!-ai/-ng/a ve-o$s es$-tsShiv Kumar Singh o <hat Kind O" S$ ge ies Ah/ad ?Ahmad Samir Alabd That &as a !o//ent o" pionee o" this b-o!1 in one o"

egiona- "o $/s### The QLB and the TAP b-o!1 a e di3e ent% &ith di3e ent dispe sion o" -o!a-anaestheti!% di3e ent /e!hanis/ o" a!tion and !o/p-ete-. di3e ent!ha a!te isti!s in te /s o" d$ ation o" a!tion#

The TAP b-o!1 in7-t ates and dispe se -o!a- bet&een inte na- ob-iE$e andt ansve s$s abdo/inis% the QLB bet&een QL and e e!to spinae and LD#

The e is no dispe sion bet&een !o/pa t/ents#

The QLB has a vis!e a- e3e!t% the TAB b-o!1 doesn't#

The QLB has a vis!e a- e3e!t% the TAB b-o!1 doesn't#

The QLB has an onset bet&een 5*() /in$tes and -asts H ho$ s% the TAPb-o!1s ta1es ;) /in$tes to &o 1 and -asts ho$ s#D Ra"ae- B-an!o %Shiv Kumar Singh I sa& this dis!$ssion b$t 1ept a&a. " o/ it de-ibe ate-.4Shiv Kumar Singh In So/e Points Ra"a Is Right% In Othe s 0e Is 9ot#

TAP B-o!1s Don't Ta1e ;) /ins To <o 1% S$ a>it !an te-- .o$ exa!t-. ho& -ongit ta1es "o the/ to &o 1# 0e is p esenting his &o 1 on II9 in TA P-ane at

9<AC Ann$a- Meeting in 9e& @o 1#

I a/ not s$ e on &hat basis he is sa.ing that QLB -asts "o H h s% Siva &o 1s&ith Ra"a and /a. be ab-e to th o& so/e -ight on it#

QLB has vis!e a- e3e!ts 4 <e-- I a/ not s$ e abo$t it#

Tho a!o*-$/ba "as!ia that !ove s this /$s!-e does !ontain s./patheti!ne ve 7b es b$t the. have got nothing to do &ith vis!e a- pain athe the.i/p-i!ated in -o& ba!1 pain#

Hetal Vadera This is " o/ C$nningha/# And it exp-ains &hat Shiv K$/aSinghsi # Logi!a--. it sho$-d b-o!1 T(+ and L( on-.4

7/25/2019 Quadratus Lumborum Block vs Tap Block

http://slidepdf.com/reader/full/quadratus-lumborum-block-vs-tap-block 5/9

Poonam !hodki Siva Kota ####p-: go th o$gh this dis!$ssion###Hetal Vadera QL and ne ves beneath it

Hetal Vadera 9e ves in TAP p-ane

Divesh Arora =e . &e-- exp-ained# <hi!h so"t&a e#Mohamad Abdul"ameer Kenani 9i!e# At-as##o h$/an bod. p og a/? ???

7/25/2019 Quadratus Lumborum Block vs Tap Block

http://slidepdf.com/reader/full/quadratus-lumborum-block-vs-tap-block 6/9

#itin T$ Patil =e . ni!e pi!s and dis!$ssion% D Shiv and D 0eta-#Hetal Vadera On the othe hand% 2xp-anation given in an a ti!-e ho& d $gsp ead ! ania--.#

Siva Kota Late to >oin# Most o" /. 1no&-edge on this is " o/ d a"ae-

b-an!o# <e no& /ade it /andato . to give E-b to a-- !esa ean patients sin!e+*8 /onths# Be"o e &e sta ted this po-i!. &e did a RCT bet&een tap and E-band "o$nd a-/ost ;)N -ess $se o" /o phine post opSiva Kota The vis!e a- !o/ponent is d$e to et og ade sp ead o" the -o!a-into pa ave teb a- spa!e as eviden!ed b. / i s!an epo ts &hi!h a"ae- did&ith his " iend# I &i-- t . to $p-oad so/e i/ages soonSiva Kota A-- the b-o!1s tap o Q-b, d$ ing the !t done b. b-an!o hi/se-"b$t &e as an assesso didnt have 1no&-edge o" &hi!h b-o!1 the patient

e!eived inside theat e#Shiv Kumar Singh Doesn't that I9TRODUC2 BIAS% @o$ <i-- t . to P ove @o$B-o!1 Bette Than the othe as that &o$-d have been the h.pothesis#

;)N ed$!tion is not i/p essive at a--#

At o$ <o/en's !ent e biggest in &ho-e o" 2$ ope ,% a-- CS Patients &e egiven PCA Mo phine BUT a$dit o" Pain e-ie" "o$nd that the. &e e ha d-.$sing an. so the p a!ti!e &as stopped#Siva Kota 0o& d shiv# <e a e the assesso and he gives b-o!1# <e dont1no& &hat b-o!1 given inside the theat e to a patient

Shiv Kumar Singh The P ob-e/ is That The LA Is In>e!ted Ante io to The

QL and Post To The Ant Tho a!o-$/ba as!ia% So Idea--. The LA Sho$-d Li/it To The A ea A o$nd QL Un-ess @o$ In>e!t LA O$tside The TL and Then It Can T a!1 To The Tho ax =ia 2ndotho a!i! as!ia#

Radio-ogi! sp ead o" !ont ast be-o& the diaph ag/% and tho a!o-$/basp ead o" !o-o ed d.e in !adave s have been des! ibed "o--o&ing TP=B in asi/i-a &a. to &hat QLB is s$pposed to do b$t $n"o t$nate-. the e isdisag ee/ent abo$t the !a$da- -i/it o" sp ead#

7/25/2019 Quadratus Lumborum Block vs Tap Block

http://slidepdf.com/reader/full/quadratus-lumborum-block-vs-tap-block 7/9

The endotho a!i! "as!ia is !ontin$o$s in"e io -. &ith the "as!ia t ansve sa-iso" the abdo/en do sa- to the diaph ag/ th o$gh the /edia- and -ate a-a !$ate -iga/ents and the ao ti! hiat$s# An in>e!tion in the -o&e TP=Sposte io to the endotho a!i! "as!ia CA9 9OT <ILL, sp ead in"e io -.

th o$gh the /edia- and -ate a- a !$ate -iga/ents to the et ope itonea-spa!e behind the "as!ia t ansve sa-is% &he e the -$/ba spina- ne ves -ie# The Sa/e Logi! 0o-ds o In>e!tion Post To T ansve sa-is as!ia and 0en!e The Dis! epan!ies In The 23e!ts Obse ved b. Peop-e#

I have hea d " o/ /an. othe s that IT DO2S 9OT AL<A@S <ORK4

In CS% Patients @2S IT <ILL &o 1 as 2xp-ained b. Me% QLB !ove s T(+ L(% TheIn!ision o CS Lies In That Te ito .4Siva Kota M. pe sona- obse vation so "a is% it ta1es !o$p-e o" ho$ s to sta ta!ting as /an. patients eE$i e a dose o" /o phine on!e spina- &ea s o3#

And then the e3e!t sta.s +H h s o /o e# H h is an exa!e bation i "ee-# Oneo" /. patient &ith to sion ova . e!eived E-b and said she &as pain " ee "oH h s and then she &anted ana-gesia a"te 8 d da.# So i !an sa. +Hh s to Hso/eti/esSiva Kota 9on obstet i!s expe ien!e :e oShiv Kumar Singh S$ a>it 0as Sho&n That I" @o$ Do II9 B-o!1 In TA P-ane AsDes! ibed B. Us 0e e% It <o 1s MUC0 bette 4Shiv Kumar Singh The P ob-e/ <as That Peop-e <e e T .ing To DoC-assi!a- TAP% <hi!h 0as 0igh ai-$ e o L( Seg/ent#Davies Verghese I have done E$ite a -a ge n$/be o" Q$ad at$sL$/bo $/ B-o!1s##

I 7nd QL ( b-o!1 tota--. $np edi!tab-e and have stopped doing it##QL + and the QL 8 T ans/$s!$-a , have have bette es$-tsJ and it hassteadi-. i/p oved ove the ti/e# QL 8 gives /e the /ost en!o$ aging

es$-ts#I "ee- that depositing the d $g in the !o e!t p-ane is ve . i/po tant#It has an onset ti/e o" ove H5 /in$tes% and has neve p ovided !o/p-eteanaesthesia o" the s1in# The e is a de7nite n$/b "ee- to the s1in#It p ovide so/e a/o$nt o" pa ieta- ana-gesia% and /a. be $se"$- as a

egiona- ana-gesia !o/ponent in /$-ti/oda- ana-gesia egi/es# The advantage o" QL B-o!1 as de!-a edJ is that it is an abdo/ina- app oa!h tothe Tho a!i! Pa a =e teb a- Spa!e4B$t ad/iniste ing TP=B is eas. and /o e de7nite $nde the U-t aso$nd

g$idan!e# It &o 1s &ithin ()*+) /in# So i" I &ant a &o 1ing b-o!1 "o s$ e% Ia-&a.s p e"e TP=B4Shiv Kumar Singh Ag ee Tota--. <ith @o$ Davies 4

The e Is Too M$!h 0.pe A o$nd This B-o!1% M. P edi!tion Is That In Ti/e The e <i-- Be Man. St$dies That <i-- P ove Its Li/ited Use#

I" @o$ 0ave To T$ n The Patient On 0is Side That Is 0o& Peop-e De/onst ate

7/25/2019 Quadratus Lumborum Block vs Tap Block

http://slidepdf.com/reader/full/quadratus-lumborum-block-vs-tap-block 8/9

QLB*8,% Then <h. 9ot $st Do P=B#

<0@ P=B IS B2TT2R

(# =e . P edi!tab-e

+# Can Be Done in Man. <a.s% An.one Can Do even i" .o$ do not have US#

8# LOR

H# P9S $ided

5# US $ide

I" @o$ A e A" aid O" Pne$/otho ax <ith P=B,% @o$ <i-- be A" aid O"P$n!t$ ing The Kidne. Too &ith QLB,#

I" @o$ P$n!t$ e The L$ng% @o$ <i-- Kno& and @o$ Can T eat#

Kidne. P$n!t$ e <i-- B-eed Unnoti!ed% o / A Ret ope itonea- 0ae/ato/aand Ma. o Un e!ognised#Herman Sehmbi Tota--. ag eedSiva Kota <e do &ith patient in s$pine position# Thats a big advantage ino$ g o$p o" patients a"te spina-Shiv Kumar Singh So .o$ don't do t ans/$s!$-a 4Siva Kota @es boss# The point o" in>e!tion is &he e the hoo1 "o /ed b.exte na- ob-iE$e ends

Hetal Vadera Toda. gave QLB ( +) /-, p-$s QLB 8 +) /-, "o ena-t ansp-ant patient# Patient is pain " eeShiv Kumar Singh QLB ( is nothing b$t Post TAP 0eta- and This Is <hat @o$a e a-so doing Siva 4Siva Kota <e go s-ight-. poste io to poste io tap and &e deposit at thepoint dista- to the t ansve se abdo/inis ends#

Shiv Kumar Singh <h. don't .o$ post a video and then &e !an de!ide&hi!h b-o!1 .o$ /a. a!t$a--. be doing#

!urunath Murthy 0eta- =ade a % !an .o$ sho& in pi!t$ es &hat .o$ /ean

b. QLB ( and QLB 8? <he e did .o$ deposit the LA?<h. I and II?

Hetal Vadera $ $nath M$ th. %I have posted a video o" QLB8# P-ease !o e!t /e i" I a/ & ong

Hetal Vadera QLB ( * it's poste io TAP o T B

7/25/2019 Quadratus Lumborum Block vs Tap Block

http://slidepdf.com/reader/full/quadratus-lumborum-block-vs-tap-block 9/9

Vicente %o&u's M. expe ien!e &ith this b-o!1 is not as espe!ta!$-a asespe!ted# I did't get bette eso$-ts &ith QL 8 than &ith QL( poste io TAP,# I&i-- 1eep on t .ing% b$t I a/ ea-i:ing that vis!e a- ana-gesia is absent o!as$a- in so/e !ases# P obab-. a good option in the !ontex o" /$-ti/oda-ana-gesia% b$t not eno$gh as epid$ a- o pa ave teb a- have sho&n# I thin1

the sa/e o" a-- "as!ia- b-o!1s "o b east s$ ge .# The. a e o1 de! easingopioid doses in postope ative% b$t "a a&a. " o/ the go-d standa dJpa ave teb a- b-o!1#