QLB type 1 has been once considered as a kind of transversus abdominis plane (TAP) block at the triangle of Petit, which can be ascribed to its similar injection points and liquid spread paths. 11,12 Moreover, QLB type 1 is reported to be an anterolateral approach, which can lead to less dispersion of local anesthetic, as observed in mag- netic resonance study. 13 Notably, there are other two types of QLB according to previous studies. 14 Among them, the standard way to conduct QLB type 2 is to set the injection point at the site posterior to the quadratus lumborum muscle from the posterior abdominal wall. 13 QLB type 3, also referred to as transmuscular quadratus lumborum block (TM-QLB), has employed the “ Shamrock Sign ” to identify muscles and aimed at the anterior border of quad- ratus lumborum and posterior to psoas major, so that the anesthetic can spread to the thoracic paravertebral space (Figure 1). 14 Additionally, it is suggested in a randomized controlled study that QLB type 2 can remarkably relieve pain following C-section. 13 However, the effects of other major QLB approaches or their combination on cesarean section have never been compared.
The demographic parameters like age, height, weight, BMI, duration of surgery were similar in both groups. The block performance time was prolonged in GROUP Q(Quadratus Lumborum Block group) as compared to GROUP T(Transversus Abdominis Plane Block group). There was no difference in hemodynamic parameters in both groups before and after performance of block. The duration of analgesia is prolonged in GROUP Q(787.14+/-377.87minutes) as compared to GROUP T (445.71+/-264.44 minutes) The number of rescue analgesic requirements and average amount of tramadol, consumption is less in GROUP Q than GROUP T(91.43+/- 61.22 mg in GROUP Q, 145.71+/- 61.8 mg in GROUP T)The mean postoperative Numerical Rating Pain Scores were less in GROUP Q as compared to GROUP T during 3,4,5,6,,8,10,12,24 hours postoperatively. No complication was noted in GROUP T, in GROUP Q one patient had transient femoral nerve palsy which recovered completely after 12 hours postoperatively.
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Effective postoperative analgesia after lower abdominal surgeries enhances early recovery, ambulation and duration of hospital stay.The effectiveness of transversus abdominis plane for post operative pain relief in abdominal surgeries have been well established.Quadratus lumborum block in recent years have gained much popularity in poatoperative pain management.However,not much studies have been conducted to directly compare and contrast the effecacies of these two blocks. . In the current study,it has been hypothesized that quadratus lumborum block would be equal to or better than the transversus abdominis plane block with regard to pain relief and its duration of action after lower abdominal surgeries.
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direct comparison between the techniques is still rare.Okusz H ,Department of Anaesthesiology,Kocaeli University Hospital,Turkey compared the 2 blocks in children undergoing lower abdominal surgeries with the conclusion that quadratus lumborum block provided longer duration and more effective analgesia than TAP block. Murouchi et al. compared the intramuscular QL block with the lateral TAP block for laparoscopic surgery. Compared to the TAP block, QL block resulted in a widespread and long-lasting analgesia after laparoscopic ovarian surgery . Blanco et al. compared the spinal anesthesia in addition to either the anterior or posterior QL block versus using only spinal anesthesia for caesarean sections.The QL block after caesarean section was effective and provided satisfactory analgesia in combination with a typical postoperative analgesic regimen. They also compared the posterior QL block with the TAP block, where the posterior QL block was found more effective in reducing morphine consumption and demands than TAP block.
Quadratus lumborum block (QLB) is a novel abdominal truncal block providing analgesia for abdominal surgery in- cluding cesarean section, laparoscopy, colostomy, pyelo- plasty and hernia repair [1–5]. Currently, there are four different approaches for QLB, with local anesthetic injected around the quadratus lumborum (QL) muscle from various directions. The QLB 1 was first proposed by Blanco in 2007: the needle is inserted into the plane between the psoas major muscle and the QL muscle and the local anesthetic is injected into the anterolateral margin of the QL muscle, which is also known as the lateral QLB . The QLB 2 approach involves injection of the anesthetic pos- terolateral to the QL muscle , and so QLB 2 is also re- ferred to as posterior QLB. Later, Børglum et al.  described another approach, transmuscular QLB (TMQLB), whereby the needle is advanced through the latissimus dorsi and the QL muscle in a posterior-anterior direction with the injection performed anterior to the QL muscle. This approach is also referred to as QLB 3 or anterior QLB. Last but not least, there is intramuscular QLB, whereby the anesthetic is injected directly into the QL muscle .
Regional analgesia is a useful method for minimizing opioid use and postoperative pain. It also could reduce mor- bidity and mortality after surgery. Epidural analgesia has excellent analgesic pro ﬁ les and decreases postoperative com- plications. Still, it could produce procedure-related compli- cations such as dural puncture, hypotension, postoperative urinary retention, and delayed mobilization. 4 Recently, inter- fascial plane block is applied for postoperative pain control in abdominal surgery. Quadratus lumborum block (QLB) is a relatively new interfascial plane block technique that injects local anesthetics adjacent to the quadratus lumborum muscle. QLB has 4 different approaches anterior, intramuscular, lat- eral, and posterior. 5 The anterior QLB injects local anes- thetics between the quadratus lumborum (QL) muscle and psoas muscle. Intramuscular QLB injects local anesthetics within the QL muscle. The lateral QLB injects the local anesthetics at the anterolateral border of the QL muscle (deep to transversalis fascia). The posterior QLB injects the local anesthetics at the posterior to the QL muscle. It provides analgesia to the abdominal wall. It potentially has a visceral analgesic effect and offers an extended sensory block area than the transversus abdominis plane block. 6,7 But there is limited evidence of analgesic effects of QLB in laparoscopic nephrectomy.
aspect and in the posterior aspect of QL muscle, respectively. TQL block was described by Borglum et al., with LA injection between QL and psoas major muscles. Comparative studies have shown that QLB covered a topographically wider field (T7–T12 for QLB versus T10–T12 for TAP), and yielded longer analgesia compared to TAP block (24–48 h for QLB versus 8–12 h for TAP block) [5,6]. The aim of this study was to compare between US-guided TQL block and US-guided OSTAP block for postoperative analgesia after upper abdominal surgeries, regarding pain scores during rest and movement, time to first opioid analgesic request postoperative, frequency of opioid administration in the first 24 h postoperative, 24 h postoperative total opioid consumption, patient satisfaction, and complications.
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adjacent to the anterolateral aspect of the Quadratus Lumborum muscle and its fascia. This block is presently utilized for a wide variety of patient populations (paediatrics, adults and pregnant women) who are undertaking abdominal surgery [10-11,15]. Whilst there have been numerous systematic reviews comparing TAP blockade to placebos, Quadratus Lumborum blockades to placebos and TAP and QL blockades to other types of analgesia (for example infiltration analgesia, spinal analgesia), currently, there have been no systematic reviews directly comparing the efficacy of Quadratus Lumborum blockade and Transversus Abdominis Plane blockade. The aim of this study was to compare the analgesic efficacy of TAP blockade versus QL blockade post abdominal surgery by performing a systematic review and meta- analysis. This study also aims to assess the association between these procedures and analgesic requirements and adverse effects.
Aim: This study evaluates the effects of three surgical procedures in the treatment of pronation deformities of the forearm in cerebral palsy patients; namely the transposition of pronator teres to extensor carpi radialis brevis muscle; and rerouting of the pronator teres muscle with or without pronator quadratus muscle myotomy. Methods: Sixty-one patients, 48 male/13 female, with a mean age of 17 years (5 – 41 years) were treated between 1971 and 2011. Pronator teres transposition was performed in 10, pronator rerouting in 35, and pronator rereouting with pronator quadratus myotomy in 16 patients. Ranges of motion, and assessments using the Quick Dash, Mayo Scoring, and Functional Classification system of upper extremity, were made before and after surgery. Mean follow-up was 17.5 years (3 – 41 years).
The activity of the m. longissimus thoracis et lumborum and the m. multifidus lumborum was monitored at three different cranio-caudal sites along the trunk (T13, L3, L6) in six mixed-breed dogs ( Canis lupus familiaris Linnaeus 1758) while they trotted on a motorized treadmill at moderate speed (~2 m s –1 ). The mean body mass of the three males and three females was 25±3 kg. All individuals were obtained from local animal shelters (UT, USA) and trained to trot on the treadmill unimpeded and under conditions of various force manipulations. Recordings started on the third or fourth day after the surgical implantation of the electrodes and continued for 5–6 days. The electrodes were removed no later than 10 days after implantation and, after a period of recovery, all dogs were adopted as pets. The study was carried out in parallel to recordings of the hindlimb protractor and retractor activity (Schilling et al., 2009) and therefore, the same experimental protocol and subjects were used in both studies. All procedures conformed to the guidelines of the University of Utah Institutional Animal Care and Use Committee (# 02-06014).
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Immunohistochemical techniques follow our earlier pro- tocols [21,22], and were used to label consecutive slides prepared from lateral and medial quadratus plantae sam- ples. Briefly, slides were removed from the freezer and air dried for 15 minutes. Blocking solution comprised of 2% bovine serum albumin and 5 mM ethylenediamine- tetraacetic acid in phosphate buffered saline (0.02 M so- dium phosphate buffer, 0.15 M sodium chloride, pH 7.2) was then applied to the slides for 30 minutes. Subse- quently, primary monoclonal antibodies were used to label myosin heavy chains of Type I fibers (antibody A4.951) or Type II fibers (antibody A4.74). Primary antibodies uti- lized in this study were raised in mouse and obtained as hybridoma supernatant from the Developmental Studies Hybridoma Bank (DSHB; University of Iowa, Iowa City, USA). Primary antibody solutions consisted of antibody diluted in blocking solution, A4.951 at a 1:20 dilution and A4.74 at 1:50, and were applied to tissue sections over- night at 4°C. A very low frequency of fiber-like structures not labelled by primary antibody A4.74 or A4.951 were detected, and an antibody directed against the myosin heavy chains of all fiber types (antibody A4.1025, DHSB; used at a 1:20 dilution) was used to confirm these un- labelled structures as muscle fibers. As the ability of anti- body A4.74 to recognize the Type IIX myosin isoform has not been definitively resolved [23,24], these unlabelled fibers may represent Type II fibers containing purely IIX myosin.
(Pette, 1985). Lastly, type IIA (fast oxidative) fibres are fast contracting fibres (less so than the type IIX fibres), and they derive their contractile properties from the expression of the MHC IIa isoform. This fibre type contains large numbers of mitochondria and can produce ATP from both aerobic and anaerobic metabolism, rendering this fibre type more resistant to fatigue (Pette, 1985; Schiaffino and Reggiani, 1996). All three fibre types also differ in the amount of maximum force and power generation capability, with type I fibres being poor at both and type IIX fibres the best (Chi et al., 1983; Essén-Gustavsson and Henriksson, 1984; Bottinelli, 2001). A fourth fibre type (type IIB expressing MHC IIb), fast twitch glycolytic, is primarily abundant in limb muscles of rodents (Pette and Staron, 1993; Delp and Duan, 1996; Kohn and Myburgh, 2007). Although small quantities of this fibre type were detected in cheetah, llama and pig limb muscles, it seems that this fibre type is reserved for more specialised muscles, such as those in the eye, and is undetectable in horse, cattle, black and blue wildebeest, blesbuck, kudu, lion, caracal and brown bear (Quiroz-Rothe and Rivero, 2001; Toniolo et al., 2005; Kohn et al., 2007; Smerdu et al., 2009; Hyatt et al., 2010; Kohn et al., 2011b; Kohn et al., 2011a). Recent investigations have shown that the vastus lateralis and longissimus lumborum muscles of feline predators (lion and caracal) exhibit a predominance of type IIX muscle fibres (>50%), with high glycolytic but relatively poor oxidative capacity (as revealed by their oxidative capacities – i.e. NADH stain, and CS and 3HAD activities) (Kohn et al., 2011b). Similar large quantities of type IIX fibres were found in tiger and cheetah muscle (Williams et al., 1997; Hyatt et SUMMARY
On the contrary, a low correlation (r = 0.78) was found between the area of the boneless loin and the area of musculus longissimus lumborum et thoracis (Figure 11). This fact can be related to the variable fat content (both intramuscular as intermuscular); the white fat tissue area then significantly influenced the total area of the loin cross-section. The high variability of the fat con- tent caused a lower correlation coefficient with the bulls (r = 0.67) in comparison to that with the cows (r = 0.85). Whereas old cows have mostly a relatively constant fat content, the fat content in old bulls is more dependent on the age.
Various strategies have been suggested to minimise the chance of flexor tendon attrition following volar plate fix- ation of distal radius fractures [5, 24]. These include placement of the plate on or proximal to the watershed line [5, 37], repair of the pronator quadratus muscle, and early removal of the plate. However, correct positioning of a volar plate for fixation of a distal radial fracture is dictated in part by the fracture pattern, the plate design and the manufacturers’ recommendations , and the surgical experience of the operator. In practice, placement of a plate that conforms to the volar anatomy of the distal radius proximal to the ‘‘watershed’’ line may not always be pos- sible . For example, sometimes the plate has to be placed very distally to provide a subchondral buttress to the palmar aspect of the articular surface or to stabilize very distal fracture types . Ideally, these situations should be avoided by choosing a suitable implant design and preop- erative planning. If the plate has to be seated more distally, then close monitoring of these patients postoperatively and removal of the plate at the first sign of flexor tendon irri- tation should be considered [16, 21, 23]. Our experience of FPL and FDP to index finger ruptures occurring 3 weeks apart shows that it is probably essential to react quickly to these complaints and intervene before complete tendon rupture follows .
45 A 15 mm steak was cut from the cranial end of the striploin for the measurement of meat colour and then myofibrillar fragmentation. A 25 mm steak cut from the central part of the striploin was placed into a plastic bag to be cooked for the measurement of cooking loss and Warner Bratzler shear force. A 40 mm steak also cut from the central part of the striploin but caudal to the 25 mm steak was used to assess the transversal surface area of the Longissimus lumborum muscle, driploss, fat colour and expressed juice. The remaining portion of the striploin at the caudal end was used to measure pH following two methods and also for the measurement of sarcomere length. After all tests had been completed the remaining lean meat was minced, vacuum packed and frozen for subsequent analysis of intramuscular fat (IMF %) content.
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The lack of significant differences between groups in the present study may be caused by PQ repair failure as well. Nevertheless, Swigart et al.  in their prospective clinical cohort study have shown that only 4 % of the PQ repairs failed within the first 3 months after surgery. The repair of the pronator quadratus muscle, however, can be frequently challenging due to various reasons such as traumatic disruption, fracture comminution or poor soft tissue quality, particularly in aged patients. For that rea- son patients presenting with open fractures and complex intra-articular fracture types were excluded from the pre- sent study. In the repair group the reconstruction of the PQ muscle could be performed in all patients. There are some few authors who state that a complete or, if not pos- sible, at least an incomplete PQ repair is the critical factor to reduce flexor tendon irritations or ruptures [4, 23]. In recent years, diverse authors have, therefore, reported on pronator sparing or splitting techniques to address this difficulty [10, 24]. The reported incidence of tendon com- plications after volar plating varies between 2 and 12 % [11, 22, 25, 26]. As opposed to this, in both groups of the present study no tendon irritations or ruptures were clinically apparent during the follow-up period and simi- lar results were also shown in the current literature .
performed on the left side, compared to without mechanical restriction. Similarly, the mechanical restriction condition had average decreases in contralateral quadratus lumborum muscle activation by 3% during single-leg squats performed on the right side and 9% during single-leg squats performed on the left side. Since there was more change in activation during single-leg squats performed on the left side for both of the muscles, it appears that these participants had differences in muscle activation patterns between sides. Athletes engage in resistance training to increase strength (Delecluse, 1997) since maximal strength in squats is associated with sprinting speed (Wisloff et al., 2004). If athletes have different activation patterns between their right and left sides during single- leg squats, then those patterns may also be present while running. One study found that female track and field athletes had significantly increased gluteus medius muscle
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A very good agreement between these two meth- ods of determination of intramuscular fat content was achieved in the musculus longissimus lumborum et thoracis (Figure 2). The digital camera takes only surface images of the cross-section and solely the fat particles that occur in the cross-section or in tightly adjoined layers could be measured while for fat de- termination by the extraction method a significantly thicker layer (approximately 10 mm) is used. But
Measures of anterior tibial muscle thickness using trans- verse and longitudinal approaches have been found to be comparable . Longitudinal scans provide several mea- surements along the length of the muscle belly offering an excellent opportunity to locate the thickest section. In contrast, transverse images only contain once slice of the muscle. For flexor hallucis brevis, measuring muscle belly thickness was more reliable than measuring cross- sectional area. The lateral borders of this muscle were often difficult to identify, possibly due to thinner and oblique orientated epimysium not producing an echogenic envelope around the entire muscle belly. The lateral bor- ders of the flexor digitorum brevis were clear in all cases and this was reflected in the cross-sectional area measure- ment being highly reliable. In some cases, the quadratus plantae displayed poorer lateral resolution, although repeatability of this measurement was still very high. Cameron et al.  reported better reliability for measur- ing the thickness of the abductor hallucis muscle (ICC = 0.97) compared to the cross-sectional area (ICC = 0.79).
Abstract: Objectives: The objective of the study was to analyze the electromyography signals of quadratus lumborum muscle activity on pelvic asymmetry and leg length inequality as this might cause serious injuries in lumbar spine and lower extremity. Subjects and Methods: This was a randomized control trial with a total of 60 participants that were all are right handed and that were assessed manually and by tape measurement for leg length inequality then by electromyography (EMG) in two positions to determine the activity of quadratus lumborum muscle. Results: In the resting position, the power spectral density to analyze the EMG signals results showed that the right side upper pelvis crista iliac position EMG signals were higher in the right than the left side of the quadratus lumborum muscle. The left side upper pelvis crista iliac position had higher EMG signals on the left side than on the right side of the quadratus lumborum muscle activity. Moreover 98% of participants who have up right iliac crista also had short LLI. Additionally, 96% of participants who had up left iliac crista also had short LLI. Conclusions: In conclusion the present study shows that asymmetry in pelvis or QL activity can be caused by LLI which might cause serious injuries in the lower extremities or lumbar spine.