The Blanco Block
The Blanco block or Raf 's block as it is known by some anaesthetists in United Kingdom is an ultrasound guided block into the quadratus lumborum space first described by Dr. R. Blanco on the 3th of May 2007 during his presentation in "Ultrasound guided blocks" at ESRA (GB&I) 2007, Annual Scientific Meeting, Exeter.Posteriorly, at the XXVI Annual ESRA Congress in Valencia,Spain, 2007.
It describes an space posterior to the abdominal wall muscles and lateral to the quadratus lumborum muscle.It has been used in abdominoplasties, caesarean sections and lower abdominal operations since 2006 providing complete pain relief in the distribution area from T6 to L1 dermatomes.in operations with peritoneum involvement the morphine comsumption was significantly reduced to less than 30% of the control groups.
The block produces distribution of the local anaesthetic extending proximally and over both sides of the surface of the quadratus lumborum muscle, in between of the anterior and intermediate layers of the thoracolumbar fascias.It also pushes the fascia transversalis and the perinephritic fat towards the peritoneum without the risk of intrabdominal puncture.
The following diagram shows the sonoanatomy pattern expected to be seen:
The approach to this point in plane with the probe in between the iliac crest and the costal margin.The position of the probe can be seen in the following picture:
To obtain this block sometimes is necessary to put a wedge under the hip of the patient to obtain the right sonoanatomy view. A 50mm block needle is sufficient in practically all the cases and the onset of action is in the range of 25 minutes from the time of injection of local anaesthetic.The volume used is 30 mls of 0.125% Levobupivacaine to obtain a good proximal spread of the local anaesthetic.It lasts for approximately 24 hours.The block does not rely on the feeling of any pops because depending of the angle of the needle several pops could be feel without reaching the target zone and causing the block to fail.
Further investigation is necessary to analyze if this block replicates the originally described by John G McDonnell with his non ultrasound guided version(2,3).
1.R. Blanco, Tap block under ultrasound guidance: the description of a “no pops” technique
XXVI Annual ESRA Congress - Valencia, Spain, 2007
Regional Anesthesia and Pain Medicine, Volume 32, Issue 5, Pages 130-130
2.McDonnell JG, O'Donnell B, Farrell T, Gough N, Tuite D, Power C, Laffey JG. Transversus abdominis plane block: a cadaveric and radiological evaluation. Reg Anesth Pain Med 2007;32:399–404[Web of Science][Medline]
3.McDonnell JG, O'Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg 2007;104:193–7[Abstract/Free Full Text]
