Ultrasound-guided Anterior Quadratus Lumborum Block for Perioperative Analgesia in Allograft Orthotopic Liver Transplantation: 4 Case Reports

Abstract

Anesthesia management for patients undergoing liver transplantation is challenging due to significant hemodynamic fluctuations and potential intraoperative awareness risk. Quadratus lumborum (QL) block is often used for anesthesia and postoperative analgesia in the patient’s abdominal surgery. In this case-series report, we present our experience with 4 patients in whom liver transplantation and early extubation were performed successfully under ultrasound-guided QL block. Four patients were scheduled for allograft orthotopic liver transplantation (AOLT), all of them were diagnosed with severe hepatitis B cirrhosis. After due deliberation and with the consent of patients and their family, a bilateral ultrasound-guided anterior QL block was performed with the patient in the lateral position. Fifteen to 20mL of 0.5% ropivacaine was injected at the front edge of the QL, bilaterally. Sensory loss to pinprick from T6 to L2 was achieved in all four patients 20 min after administration of blocks. The operation went smoothly for all the patients. All four patients experienced quiet recovery and early extubation, and none of them complained of discomfort in the surgical side in the first 12h after surgery. Here we present 4 cases of ultrasound-guided anterior QL block that may be an attractive option for anesthetic management of AOLT in clinical practice.