A Novel Approach for Transmuscular Quadratus Lumborum Block

With this approach, we think it has advantages of easy identification, better caudal LA spread till under fascia iliaca, with the psoas major muscle provides a better protective barrier against accidental needle entry into the peritoneal cavity, the endpoint is injection within a fascial plane, rather than a specific motor response contact where the lumbar plexus stimulation is not sought, so there is minimal risk of nerve injury, inadvertent dural cuff puncture and intrathecal spread of local anesthetic. And finally optimal insertion of catheter in long axis of Q.L and psoas major if continuous analgesia is planned.

Inclusion criteria

• Orthopaedic patients, American Society of Anesthesiologists (ASA) physical status I-III, scheduled to undergo unilateral hip surgery.

Exclusion criteria

• History of neurological/neuromuscular, psychiatric disease, dementia preventing proper comprehension.
• Patients with Body Mass Index (BMI) <18.5 or >30 kg/m2.
• Coagulation disturbances (INR>1.4, platelet count<100 000).
• History of opioid dependence (opioid use within the last 4 weeks).
• History of allergies to study medications.