Description of a novel ultrasound-guided approach for a dorsal quadratus lumborum block: a canine cadaver study

Objective To describe an ultrasound-guided approach to the dorsal aspect of the quadratus lumborum muscle (D-QL) and to evaluate the spread of methylene blue dye in canine cadavers. Study design Prospective, experimental anatomical study. Animals A total of 12 canine cadavers. Methods The ultrasonographic landmarks and injection technique for the D-QL approach were determined in two cadavers. Correct needle tip position was confirmed by computed tomography. Bilateral ultrasound-guided injections were performed in 10 cadavers between the QL muscle, the vertebral body and the ventrocaudal aspect of the transverse process of the first lumbar vertebra (L1) using two volumes of methylene blue: low volume (LV) 0.3 mL kg-1 or high volume (HV) 0.5 mL kg(-1). Staining of the main thoracolumbar trunk, dorsal and ventral branches of the thoracic (T) and lumbar (L) spinal nerves, sympathetic trunk and epidural space were assessed following dissection. Data between groups were compared using Mann-Whitney U test. Data are presented as median (range). Results The ventral branches of spinal nerves T12, T13, L1, L2, L3 and L4 were stained in 10%, 70%, 100%, 90%, 60%, 0% and 30%, 100%, 100%, 100%, 50% and 30% after LV and HV injections, respectively. Multisegmental spread of the sympathetic trunk was found on 3 (3-4) and 5 (3-6) vertebral spinal levels following LV and HV injections, respectively (p = 0.005). The T13 segment of the sympathetic trunk was stained after all HV injections. Epidural spread was found in 20% and 30% of LV and HV injections, respectively. Conclusions and clinical relevance The injection of HV versus LV dye using the D-QL approach provided more consistent staining of the thoracolumbar nerve structures which innervate the abdominal wall and viscera. Clinical studies are required to evaluate the analgesic efficacy of the D-QL block for abdominal procedures in dogs in vivo.