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The Influence of an International Teaching Visit on the Use of Quadratus Lumborum Block in Leskovac General Hospital, Serbia
Abstract Number: F1A-5
Abstract Type: Original Research
Introduction: The Quadratus lumborum block (QLB) is a posterior abdominal wall block that’s performed only under ultrasound guidance. It has been described as a variant of the transversus abdominal plane (TAP) block in 2007 by Raphael Blanco. Neither TAP block nor QLB for post-operative pain management were used in Serbia prior to April of 2017. Members of the Department of Anesthesia at Leskovac General Hospital, Serbia (LGH), asked for help in order to train physicians in the use of regional anesthesia (RA) techniques for obstetrics, gynecology and general surgery cases. Based on the success of the Kybele program, we decided to do a similar program within the area of peripheral nerve (trunk) anesthesia. A 4 day teaching visit by a fellowship trained regional anesthesiologist and 5 day visit by a fellowship trained obstetric anesthesiologist from the USA were arranged.
Methods:Using the LGH anesthesia database from the period 4/24/17 to 12/31/17 data on all Cesarean Delivery (CD) and gynecology cases were obtained. All cases where QLB was used were checked for quality of pain relief. Two of the local anesthesiologists were actively involved in performing regional blocks under the supervision of US anesthesiologist and then they continued doing QLBs on their own.
Results: During the study period, 433 CD and 117 hysterectomies were done at LGH; 331 (76.44%) CD were done under general anesthesia (GA), 98 (22.63%) CD were done under spinal anesthesia (SA), 1 (0.23%) case was performed under combine spinal – epidural (CSE), and 3 cases (0.70%) under SA and GA. 109 (93.16%) all of hysterectomies were done under GA, 4 (3.42%) cases were done under SA, 2 (1.71%) cases were done under CSE, and 2 (1.71%) under SA and GA. QLB was performed for post-operative pain management in 30 CD and 21 hysterectomies. We performed bilateral QL type 1 block in 42 patients after recovery from GA, and in 9 patients after recovery from spinal anesthesia for postoperative pain management. 48 (94.12%) of the patients with QLB had an adequate postoperative pain control (0-2/10 VAS score). As a result of the visit, the expertise of local physicians progressively increased. By day number 4, two members of the department were ready to do blocks independently. Over the next 6 months, 3 other members of the department started doing block under the supervision of more experienced members.
Conclusion: In order for LGH to become recognized as a leading facility in RA, the use of RA techniques must increase. A several day teaching visit can significantly improve the skills of local anesthesiologists. It is important to focus on only a few blocks, so that the local team can gain experience in blocks that their patients need. We plan to monitor RA use at LGH in the next 12 months. Future visits are planned in order to evaluate performance of trained people, teach local anesthesiologists additional peripheral nerve blocks and train physicians from surrounding hospitals.