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The Influence of an International Teaching Visit on the Use of the Quadratus Lumborum Block after Cesarean Delivery in Serbia
Abstract Number: F3A-116
Abstract Type: Original Research
Background: The Quadratus Lumborum Block (QLB) is a posterior abdominal wall block that is performed exclusively under ultrasound guidance. Since 2015, QLB has been used for pain management after Cesarean Delivery (CD). A teaching visit by a fellowship trained anesthesiologists from the USA was arranged to Leskovac General Hospital (LGH) in April of 2017. Two anesthesiologists from LGH learned how to perform QLB and later on held a teaching sessions around the region in order to train other anesthesiologists.
Methods: All CD cases followed by QLB performance done during the period April 2017 – December 2018 were obtained from the anesthesia databases of LGH, Sremska Mitrovica General Hospital (SMGH), and Clinic of Gynecology and Obstetrics, Clinical Center of Vojvodina (CCV). Bilateral QLB type 1 was performed after CD done under either general anesthesia (GA) or spinal anesthesia (SA). QLB was performed either in the OR at the end of the surgery or in the recovery room. All patients that had QLB were checked for pain relief.
Results: In LGH, QLB was performed in 29 patients after CD done under GA, and in 12 patients after CD under SA. In CCV, QLB was performed in 56 patients after CD done under GA, and in 84 patients after CD under SA. In SMGH, QLB was performed in 4 patients after CD done under GA. All patients experienced significant pain relief after block performance, 0 to 2/10 on a numeric rating scale. In total, QLB was done in 34 patients in 2017 and in 151 patients in 2018, an increase of 332%.
Conclusions: QLB was introduced into LGH everyday clinical practice thanks to an international teaching visit (Kybele program1). Over the next year, two members of the department have trained physicians from other hospitals in the region. New regional workshops are planned in order to train additional physicians. New international visits are also planned in order to train local physicians new blocks. QLB can be easily performed thanks to the clear sonographic landmarks. QLB has almost eliminated postoperative opioid use in our patients. QLB can be used in CD patients done under either GA or SA. Successful implementation of QLB has started the interest in abdominal wall blocks in several Balkan countries.
References: 1. Baysinger C. et al. Increasing Regional Anesthesia Use in a Serbian Teaching Hospital through International Collaboration. Front. Public Health 09 June, 2017.