BMJ Case Reports 2017; doi:10.1136/bcr-2017-219680
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

Novel use of combination of electromyography and ultrasound to guide quadratus lumborum block after open appendicectomy

  1. Therese C O'Connor1
  1. 1Anaesthesia, Intensive Care and Pain Medicine, Sligo University Hospital, Sligo, Ireland
  2. 2Neurophysiology, Sports Surgery Clinic, Dublin, Ireland
  3. 3Sports Medicine, Blackrock Clinic, Dublin, Ireland
  1. Correspondence to Dr Cormac F Mullins, cormacmullins1{at}
  • Accepted 5 April 2017
  • Published 15 May 2017


The quadratus lumborum (QL) block facilitates the administration of anaesthesia to the anterior abdominal wall. The use of ultrasound (US) improves the accuracy of the QL block and reduces the risk of adverse events. Electromyography (EMG) in combination with US for muscle plane blocks has not been described previously. We postulated that the addition of EMG-guided needle positioning might assist the execution of this block. This case report describes the first use of combined needle EMG and US to carry out a QL block performed for postoperative analgesia following an open appendicectomy.


  • Contributors CFM and TCO conceived this project and liaised with CO for his expertise in the use of electromyography. The patient in question was admitted under the care of CFM and TCO. The nerve block was performed by CFM under the supervision of TCO and the patient was followed up by CFM.

    The case report and video were written and edited by CFM and sent to CO and TCO for revisions. All authors approved the final draft prior to submission and have agreed to be responsible for the integrity of the article.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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