Quadratus Lumborum Block

Excerpt

Regional anesthesia is an important component of multimodal perioperative analgesia, particularly when the goal is to improve pain control, reduce opioid exposure, and facilitate early mobilization after surgery. Healthcare professionals have used neuraxial anesthesia, peripheral nerve blocks, and truncal fascial plane blocks to provide analgesia for thoracic, abdominal, pelvic, and selected lower-extremity procedures. However, neuraxial techniques may be limited by patient refusal, anticoagulation status, infection risk, hemodynamic concerns, or technical difficulty. These limitations have increased interest in ultrasound-guided truncal blocks that can supplement systemic analgesia while avoiding some risks associated with central neuraxial approaches.

The quadratus lumborum block is an ultrasound-guided interfascial plane block that evolved from the transversus abdominis plane (TAP) block. Unlike a classic TAP block, which primarily targets nerves within the fascial plane between the internal oblique and transversus abdominis muscles, the quadratus lumborum block involves local anesthetic deposition adjacent to the quadratus lumborum muscle and thoracolumbar fascia (see Image. Lateral ultrasonographic view of Quadratus Lumborum Muscle). This location may allow wider craniocaudal spread and possible extension toward the thoracic paravertebral region, contributing to somatic and visceral analgesia.

Several quadratus lumborum block approaches have been described, including lateral, posterior, anterior, transmuscular, and intramuscular techniques. The block has most often been studied for postoperative analgesia after abdominal, obstetric, gynecologic, urologic, and selected hip procedures. A 2025 systematic review and meta-analysis found that an anterior quadratus lumborum block at the lateral supra-arcuate ligament reduced 24-hour postoperative opioid consumption and postoperative nausea and vomiting after abdominal surgery.

Recent randomized trials also support the use of the quadratus lumborum block as part of opioid-sparing perioperative analgesia for selected lower abdominal, pelvic, and urologic procedures. In a 2024 randomized controlled trial, ultrasound-guided quadratus lumborum block in the supine position was associated with stable intraoperative vital signs, faster recovery, and improved postoperative analgesia during opioid-free anesthesia for lower abdominal or pelvic surgery. In another randomized controlled trial, a single-injection preemptive quadratus lumborum block reduced early postoperative pain scores and opioid consumption after robot-assisted partial nephrectomy.