A comparative study between transmuscular quadratus lumborum block and oblique subcostal transversus abdominis plane block for analgesia following upper abdominal surgeries

Background: Ultrasound (US)-guided transmuscular quadratus lumborum (TQL) block and oblique subcostal transversus abdominis plane (OSTAP) block are components of multimodal analgesia for abdominal surgeries.The aim of the study is to compare the analgesic efficacy of US-guided TQL block versus US-guided OSTAP block after upper abdominal surgeries.Methods: This prospective randomized study was conducted on 40 patients scheduled for elective open upper abdominal surgery under general anesthesia. Patients were randomly allocated into2groups; OSTAPGroup (20 patients) received US-guided OSTAP block, and TQL Group (20 patients) received US-guided TQL block. At the end of surgical procedure, while patients were still under general anesthesia, each group received 30 mL bupivacaine 0.25%. Postoperative measurements included pain scores, time to first opioid analgesic request, postoperative total opioid consumption, patient satisfaction, and complications.Results: Patients of TQL group had statistically significant lower 24 h postoperative total morphine consumption than patients of OSTAP group (13.25±2.88 mg and 20.10±3.21 mg, respectively,P < 0.001), and longer time to first opioid analgesic request (373.25±18.76 min. and 245.75±11.50 min., respectively,P < 0.001). Patients received TQL block had also statistically significant lower postoperative pain scores, less frequent morphine doses, and more patient satisfaction.Conclusion: US-guided TQL block is more effective postoperative analgesic modality than US-guided OSTAP block in patients undergoing elective open upper abdominal surgery under general anesthesia

Retalho do músculo oblíquo externo para reconstrução de extenso defeito da parede torácica após ressecção de carcinoma de mama recidivado / External oblique muscle flap for reconstruction of large chest wall defect after resection of recurrent breast cancer

A reconstrução de extensos defeitos da parede torácica secundárias à ressecção de tumores avançados é desafiadora ao cirurgião plástico. Relatamos o caso de uma paciente com recidiva locorregional de carcinoma ductal de mama, que resultou em grande perda de substância da parede torácica anterior após sua ressecão. O defeito foi reconstruído com retalho miocutâneo do músculo oblíquo externo (MOE). O retalho miocutâneo do MOE possui diversas vantagens sobre os demais retalhos possíveis para a reconstrução de extensos defeitos da parede torácica, como um menor tempo cirúrgico e uma menor morbidade (AU)

The reconstruction of large defects of the chest wall secondary to resection of advanced tumors is challenging to the plastic surgeon. Here we report the case of a patient with locoregional recurrence of breast ductal carcinoma, which resulted in great loss of substance of the anterior chest wall after its resection. The defect was reconstructed with myocutaneous flap of the external oblique muscle (EOM). The myocutaneous flap of EOM has several advantages over other possible flaps for the reconstruction of extensive defects of the chest wall, such as reduced surgical time and lower morbidity (AU)