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Ultrasound-Guided Quadratus Lumborum Block as a Sole Anesthetic Method for Giant Inguinal Herniorrhaphy in an Elderly Patient with High Risk

Received: 14 January 2024     Accepted: 29 January 2024     Published: 5 February 2024
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Abstract

Background: Quadratus lumborum (QL) block is a fascial plane block where local anesthetic is injected adjacent to the quadratus lumborum muscle to provide effective analgesia for abdominal procedures. We presented the feasibility of using this technique as the sole anesthetic technique for giant inguinal herniorrhaphy repair by observing intraoperative and postoperative analgesic effects in patients. Case: We present an elderly patient with complex comorbidities who was hospitalized for a left inguinal hernia that fell into the scrotum and formed a huge hernial sac. Comorbidities include hypertension, atrial fibrillation, and chronic obstructive pulmonary disease. After adequate preoperative evaluation, the anesthesiologist scheduled to perform QL block as the sole anesthetic technique to complete a giant inguinal herniorrhaphy with 30 mL of ropivacaine (0.33%). Intraoperative hemodynamics was stable, the patient did not complain discomfort and pain. And no additional analgesics or local infiltration anesthesia was required. The patient was able to move 6 hours after surgery and received the first analgesia 14 hours later. He was discharged one day later, without recurrence after one year of follow-up. Conclusions: Our experience suggests that QL block with 30 mL of ropivacaine (0.33%) may be an effective intraoperative anesthesia technique suitable for elderly patients with complex complications undergoing giant inguinal hernia repair surgery, and a represents a viable alternative approach to general and neuraxial anesthesia.

Published in International Journal of Anesthesia and Clinical Medicine (Volume 12, Issue 1)
DOI 10.11648/ijacm.20241201.12
Page(s) 7-10
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Quadratus Lumborum Block, Inguinal Herniorrhaphy, Anesthetic Method

References
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[2] Elsharkawy, H., El-Boghdadly, K., Barrington, M. Quadratus Lumborum Block: Anatomical Concepts, Mechanisms, and Techniques. Anesthesiology. 2019, 130(2), 322-335. doi: 10.1097/aln.0000000000002524.
[3] Altınay, M., Türk, H. Comparison of the Analgesic Efficacy of Ultrasound-Guided Quadratus Lumborum Block and Ilioinguinal-Iliohypogastric Nerve Block in Paediatric Patients After Inguinal Hernia Surgery: A Prospective Randomized Controlled Trial. Turkish journal of anaesthesiology and reanimation. 2023, 51(5), 443-449. doi: 10.4274/tjar.2023.231289.
[4] Priyadarshini, K., Behera, B. K., Tripathy, B. B., et al. Ultrasound-guided transverse abdominis plane block, ilioinguinal/iliohypogastric nerve block, and quadratus lumborum block for elective open inguinal hernia repair in children: a randomized controlled trial. Regional anesthesia and pain medicine. 2022, 47(4), 217-221. doi: 10.1136/rapm-2021-103201.
[5] Samerchua, A., Leurcharusmee, P., Panichpichate, K., et al. A Prospective, randomized comparative study between ultrasound-guided posterior quadratus lumborum block and ultrasound-guided ilioinguinal/iliohypogastric nerve block for pediatric inguinal herniotomy. Paediatric anaesthesia. 2020, 30(4) 498-505. doi: 10.1111/pan.13837.
[6] Yadav, M., Agrawal, M., Bansal, P., et al. Ultrasound-guided quadratus lumborum block versus ilioinguinal-iliohypogastric nerve block with wound infiltration for postoperative analgesia in unilateral inguinal surgeries: A randomised controlled trial. Indian journal of anaesthesia. 2023, 67(3), 302-306. doi: 10.4103/ija.ija_578_22.
[7] Singh, R., Byam, J., Radwan, R. W., et al. Local or general anesthesia when repairing inguinal hernias? American journal of surgery. 2021, 222(1), 52. doi: 10.1016/j.amjsurg.2020.11.017.
[8] Zhang, H., Gu, F., Liu, Y., et al. The analgesic efficacy of paravertebral block at T11 level as a single anaesthetic technique in an older adult with severe cardiac insufficiency undergoing open complex inguinal hernia repair: A case report. Heliyon. 2023, 9(4), e14962. doi: 10.1016/j.heliyon.2023.e14962.
[9] Sasaoka, N., Kawaguchi, M., Yoshitani, K., et al. Evaluation of genitofemoral nerve block, in addition to ilioinguinal and iliohypogastric nerve block, during inguinal hernia repair in children. British journal of anaesthesia. 2005, 94(2), 243-246. doi: 10.1093/bja/aei031.
[10] Tagliafico, A., Bignotti, B., Cadoni, A., et al. Anatomical study of the iliohypogastric, ilioinguinal, and genitofemoral nerves using high-resolution ultrasound. Muscle & nerve. 2015, 51(1), 42-48. doi: 10.1002/mus.24277.
[11] Chin, K. J., McDonnell, J. G., Carvalho, B., et al. Essentials of Our Current Understanding: Abdominal Wall Blocks. Regional anesthesia and pain medicine. 2017, 42(2), 133-183. doi: 10.1097/aap.0000000000000545.
[12] Reinpold, W., Schroeder, A. D., Schroeder, M., et al. Retroperitoneal anatomy of the iliohypogastric, ilioinguinal, genitofemoral, and lateral femoral cutaneous nerve: consequences for prevention and treatment of chronic inguinodynia. Hernia: the journal of hernias and abdominal wall surgery. 2015, 19(4), 539-548. doi: 10.1007/s10029-015-1396-z.
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[15] Polo-Paredes, G., Laredo, F. G., Gil, F., et al. Modified Ultrasound-Guided Dorsal Quadratus Lumborum Block in Cat Cadavers. Animals: an open access journal from MDPI. 2023, 13(24). doi: 10.3390/ani13243798.
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  • APA Style

    Zhang, G., Xu, M., Wang, X. (2024). Ultrasound-Guided Quadratus Lumborum Block as a Sole Anesthetic Method for Giant Inguinal Herniorrhaphy in an Elderly Patient with High Risk. International Journal of Anesthesia and Clinical Medicine, 12(1), 7-10. https://doi.org/10.11648/ijacm.20241201.12

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    ACS Style

    Zhang, G.; Xu, M.; Wang, X. Ultrasound-Guided Quadratus Lumborum Block as a Sole Anesthetic Method for Giant Inguinal Herniorrhaphy in an Elderly Patient with High Risk. Int. J. Anesth. Clin. Med. 2024, 12(1), 7-10. doi: 10.11648/ijacm.20241201.12

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    AMA Style

    Zhang G, Xu M, Wang X. Ultrasound-Guided Quadratus Lumborum Block as a Sole Anesthetic Method for Giant Inguinal Herniorrhaphy in an Elderly Patient with High Risk. Int J Anesth Clin Med. 2024;12(1):7-10. doi: 10.11648/ijacm.20241201.12

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  • @article{10.11648/ijacm.20241201.12,
      author = {Guangchao Zhang and Min Xu and Xiao Wang},
      title = {Ultrasound-Guided Quadratus Lumborum Block as a Sole Anesthetic Method for Giant Inguinal Herniorrhaphy in an Elderly Patient with High Risk},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {12},
      number = {1},
      pages = {7-10},
      doi = {10.11648/ijacm.20241201.12},
      url = {https://doi.org/10.11648/ijacm.20241201.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.ijacm.20241201.12},
      abstract = {Background: Quadratus lumborum (QL) block is a fascial plane block where local anesthetic is injected adjacent to the quadratus lumborum muscle to provide effective analgesia for abdominal procedures. We presented the feasibility of using this technique as the sole anesthetic technique for giant inguinal herniorrhaphy repair by observing intraoperative and postoperative analgesic effects in patients. Case: We present an elderly patient with complex comorbidities who was hospitalized for a left inguinal hernia that fell into the scrotum and formed a huge hernial sac. Comorbidities include hypertension, atrial fibrillation, and chronic obstructive pulmonary disease. After adequate preoperative evaluation, the anesthesiologist scheduled to perform QL block as the sole anesthetic technique to complete a giant inguinal herniorrhaphy with 30 mL of ropivacaine (0.33%). Intraoperative hemodynamics was stable, the patient did not complain discomfort and pain. And no additional analgesics or local infiltration anesthesia was required. The patient was able to move 6 hours after surgery and received the first analgesia 14 hours later. He was discharged one day later, without recurrence after one year of follow-up. Conclusions: Our experience suggests that QL block with 30 mL of ropivacaine (0.33%) may be an effective intraoperative anesthesia technique suitable for elderly patients with complex complications undergoing giant inguinal hernia repair surgery, and a represents a viable alternative approach to general and neuraxial anesthesia.
    },
     year = {2024}
    }
    

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  • TY  - JOUR
    T1  - Ultrasound-Guided Quadratus Lumborum Block as a Sole Anesthetic Method for Giant Inguinal Herniorrhaphy in an Elderly Patient with High Risk
    AU  - Guangchao Zhang
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    T2  - International Journal of Anesthesia and Clinical Medicine
    JF  - International Journal of Anesthesia and Clinical Medicine
    JO  - International Journal of Anesthesia and Clinical Medicine
    SP  - 7
    EP  - 10
    PB  - Science Publishing Group
    SN  - 2997-2698
    UR  - https://doi.org/10.11648/ijacm.20241201.12
    AB  - Background: Quadratus lumborum (QL) block is a fascial plane block where local anesthetic is injected adjacent to the quadratus lumborum muscle to provide effective analgesia for abdominal procedures. We presented the feasibility of using this technique as the sole anesthetic technique for giant inguinal herniorrhaphy repair by observing intraoperative and postoperative analgesic effects in patients. Case: We present an elderly patient with complex comorbidities who was hospitalized for a left inguinal hernia that fell into the scrotum and formed a huge hernial sac. Comorbidities include hypertension, atrial fibrillation, and chronic obstructive pulmonary disease. After adequate preoperative evaluation, the anesthesiologist scheduled to perform QL block as the sole anesthetic technique to complete a giant inguinal herniorrhaphy with 30 mL of ropivacaine (0.33%). Intraoperative hemodynamics was stable, the patient did not complain discomfort and pain. And no additional analgesics or local infiltration anesthesia was required. The patient was able to move 6 hours after surgery and received the first analgesia 14 hours later. He was discharged one day later, without recurrence after one year of follow-up. Conclusions: Our experience suggests that QL block with 30 mL of ropivacaine (0.33%) may be an effective intraoperative anesthesia technique suitable for elderly patients with complex complications undergoing giant inguinal hernia repair surgery, and a represents a viable alternative approach to general and neuraxial anesthesia.
    
    VL  - 12
    IS  - 1
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Author Information
  • Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China

  • Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China

  • Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China

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