Quadratus Lumborum Block for Ovarian Cystectomy Surgery in a Patient With Severe Kyphoscoliosis

• Published in: Curēus (Palo Alto, CA) Vol. 16; no. 1; p. e51513
• Main Authors: Beh, Zhi Yuen, Mok, Chuang Shin, Lim, Woon Lai, Yip, Hing Wa, Loh, Pui San, Ramli, Mohd Afiq Syahmi, Omar, Siti Zawiah
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 02.01.2024; Cureus
• Subjects: Abdomen; Activities of daily living; Analgesics; Anesthesia; Anesthesiology; Case reports; Cysts; Ketamine; Lung diseases; Morphine; Ovaries; Surgeons; Tomography; Ultrasonic imaging; Urological surgery; Germany; abdominal laparotomy; ovarian cystectomy; ultrasound guided nerve block; anesthesia and analgesia; type 3 osteogenesis imperfecta; regional anesthesia
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.51513

Quadratus lumborum block (QLB) has been described as a regional analgesic technique in various abdominal surgeries. We present a case report of a high-risk patient who underwent ovarian cystectomy with QLB and deep sedation after failed neuraxial anesthesia. A 29-year-old female patient with comorbidities osteogenesis imperfecta, severe kyphoscoliosis with restrictive lung disease, and cervical syringomyelia with cranio-cervical junction stenosis (C2/C3). The patient had large ovarian cysts with associated dyspnea. She accepted surgery-an open bilateral ovarian cystectomy-despite being advised that general anesthesia would be high-risk. Regional anesthetic options were limited and challenging, given her anatomy and difficulty in positioning. Neuraxial anesthesia was attempted but was unsuccessful. The patient safely underwent surgery (lower midline laparotomy) using QLB. This clinically challenging case demonstrates the feasibility of QLB as the mainstay multimodal anesthetic approach (without general and neuraxial anesthesia) for abdominal surgery under exceptional circumstances.