Disclosures: Quintin Pedro Solano, BS: Nothing to disclose

Case Description: The patient developed chronic abdominal wall and neuropathic pain, reporting significant functional and quality of life limitations. After failed conservative treatment with physical therapy, medication management, and alternative medicine (eg acupuncture), he was initially offered an ultrasound-guided transversus abdominis plane (TAP) block. At 3-month follow up, he noted 50% improvement but with incomplete coverage of his pain. He was offered a quadratus lumborum (QL) block in order to provide more extensive abdominal wall analgesia. Using real-time US-guidance, utilizing a QL-2 approach, a mixture of 19 mL of 0.25% bupivacaine and 1 mL of dexamethasone (10 mg/mL) was injected to the dorsal surface of the QL muscle and the overlying latissimus dorsi and paraspinal musculature within the thoracolumbar plane on the right.

Setting: Outpatient VA PM&R/Pain Medicine Clinic

Patient: 69-year-old male veteran referred for abdominal pain following a partial nephrectomy secondary to a renal cell carcinoma 5 years prior.

Assessment/Results: Immediately following the procedure and at 6-week follow-up, the patient was pain-free at rest and reported 4/10 exertional pain, compared with his baseline, constant 7/10 pain score.

Discussion: The QL block has been demonstrated to provide patients with abdominal wall pain relief in post-operative and chronic pain settings with a single injection US-guided abdominal wall blocks with local anesthetic and corticosteroid possibly due to its spread to the thoracic paravertebral space and duration of its effect. This patient appears to have experienced improved abdominal analgesia with US-guided QL block compared to the TAP block.

Conclusion: To our knowledge, no prior studies have compared both US-guided QL and TAP blocks in a single patient, or the consideration of QL block in the setting of abnormal post-operative anatomy. Studies should be considered to define a diagnostic algorithm when considering TAP and QL blocks for pain management. Further long-term follow-up would be helpful in determining duration of effect.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-guided-quadratus-lumborum-block-in-chronic-abdominal-wall-pain-after-partial-nephrectomy-case-report/