Post block exam expected for QL and ES?

[ethilo]

Hi all,
I've been learning the QL block and trying to use it as much as possible. I feel pretty confident I have it down, I usually do it before surgery, my dose is typically 25 mL Bupi 0.25% + 1:400k epi + 6 mg decadron + 5 mL saline. I do this for each side. It seems like narcotic requirements intraop are less with the block.

Despite this and getting good visualization with US, in PACU I rarely have any numbness/tingling on exam. Is that a typical finding with this block? I'm trying to tell if I'm doing it right, however I'm wondering if since it's a fascial plane block the exam is going to be mild and inconsistent at best.

Along these same lines, will an erector spinae block have any kind of consistent exam to evaluate for?

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[AdmiralChz]

That’s a hefty dose of local - 125 mg of bupivacaine total. Beware in small patients.

QL is definitely a plane block, as is ESP.

We trailed QL blocks for a time in our practice, seemed more trouble than it was worth. Haven’t done one in close to 2 years I’d wager

 

[ethilo]

So what I'm gathering from this post is that no one knows what the post-op exam is supposed to look like and that is ok?

 

[ethilo]

That’s a hefty dose of local - 125 mg of bupivacaine total. Beware in small patients.

QL is definitely a plane block, as is ESP.

On a 70 kg patient, less than 2 mg/kg. From what I've been trained that's pretty safe, yeah?

 

[AdmiralChz]

On a 70 kg patient, less than 2 mg/kg. From what I've been trained that's pretty safe, yeah?

Yes but it’s a lot for a 50kg hence my comment. Also the epinephrine doesn’t change the toxic dose like lidocaine. Seems like a lot, but as I said we don’t do much QL these days.

 

[koan]

I’m assuming you’re doing QLB1 / anterior approach. We don’t routinely do a post-block exam, and rarely perform them (when we do it’s with 20-30mL of 0.2% ropivacaine per side). Last one I did was for THA in a complex pain pt with contraindication to neuraxial, worked better than I expected.

NYSORA has some images of contrast injected into this plane to give you some idea of what to expect in terms of spread.

 

[anbuitachi]

We do 30-40ml per side of 0.25, up to total max dose of whatever kg the patient weighs, in ml.
i never noticed any numbness post op.
then again i think its effects are questionable but i definitely find it to be a more challenging block especially in our obese population