Comparison of dorsoventral and ventrodorsal approaches for ultrasound-guided quadratus lumborum block in cats: a cadaver study

Abstract

ObjectiveTo assess the feasibility of an ultrasound (US)-guided quadratus lumborum (QL)-psoas muscle (Pm) interfascial plane injection using a dorsoventral (DV) approach, and to compare needle visualization and distribution pattern between DV and ventrodorsal (VD) approaches. Study designExperimental anatomical study. AnimalsA total of 14 cat cadavers. MethodsBilateral in-plane US-guided injections in the QL-Pm plane were performed at the level of the second lumbar (L2) transverse process. A spinal needle was inserted using either a VD or DV approach. A total volume of 0.4 mL kg–1 of a solution of ropivacaine 0.18%, tissue dye and iohexol (350 mg mL–1), in a proportion of 3:1:1, respectively, was injected bilaterally. Spread of injectate was compared and evaluated using US, computed tomography (CT) scanning and anatomical dissection. Presence of dye on the sympathetic trunk was compared between methods using Kappa (κ) coefficient of agreement. ResultsThe QL-Pm plane was visualized, and dye was present in the target plane using both approaches. Needle visualization in the VD approach was enhanced compared with the DV approach (p = 0.0005). Mean distribution along the sympathetic trunk was 4.8 and 4.1 segments in the VD and DV approaches, respectively, showing non-statistical differences. The ventral branches of L1, L2 and L3 were successfully stained in 11/14 and 6/14 using the VD and DV approaches, respectively. Substantial agreement (κ = 0.61) of sympathetic trunk staining was observed between CT scan and anatomical dissection. Dye was observed cranial to the diaphragm in 7/8 cases on CT with both approaches. Epidural and abdominal cavity dye distribution was not observed. Conclusions and clinical relevanceThe DV approach to the QL-Pm plane could be an alternative to the VD approach. Both approaches seem capable of reaching the spinal nerves, the sympathetic trunk and both splanchnic and coeliac nerves in feline cadavers.