Quadratus Lumborum Block: a Technical Review

Abstract

Purpose of Review Ultrasound-guided quadratus lumborum block (QLB) is gaining popularity in regional anesthesia for various surgical procedures. The purpose of this review is to understand the relevant clinical anatomy, different mechanisms of actions, and techniques used for the block and clinical evidence so far. Recent Findings The current data suggests a wide dermatomal distribution of the local anesthetic from T7-L2. The evidence regarding its utility is still evolving but has shown reduced opioid requirements for cesarean sections, lower abdominal surgery, and hip surgery. Prolonged analgesia has been reported as compared with more conventional transversus abdominis plane (TAP) block. This block has also been reported for above knee amputation, femoral-pop bypass, lumbar laminectomy and fusion, iliac crest bone graft, and iliac and acetabulum fracture. Summary Quadratus lumborum can be performed through different approaches which requires sound knowledge of anatomy. Further research to determine which approach yields best results is warranted.

A Retrospective Case Series of Pericapsular Nerve Group (PENG) Block for Primary Versus Revision Total Hip Arthroplasty Analgesia

“…Quadratus lumborum (QL) block is a relatively new regional block found to provide effective analgesia after primary THA, but it can indirectly block lumbar plexus branches and may cause some motor weakness [9]. It is also a deep block and therefore contraindicated in patients on anticoagulation [10].…”

Ultrasound-guided anterior quadratus lumborum block for postoperative pain after laparoscopic pyeloplasty: A randomized controlled trial

“…The drug then seeps cephalad to thoracic paravertebral space, through the arcuate ligament of diaphragm, and blocks the thoracic somatic nerves. [ 13 ] Since the block was performed after completion of surgery, the seepage of drug and blockade of somatic nerves may not have been achieved by the 30 th min time point. By the 2 nd hour after surgery, the blockade of all somatic and visceral fibers in paravertebral space[ 13 ] and TLF[ 2 ] may have been completed to provide significantly better pain scores then and thereafter.…”

“…[ 13 ] Since the block was performed after completion of surgery, the seepage of drug and blockade of somatic nerves may not have been achieved by the 30 th min time point. By the 2 nd hour after surgery, the blockade of all somatic and visceral fibers in paravertebral space[ 13 ] and TLF[ 2 ] may have been completed to provide significantly better pain scores then and thereafter. The VAS scores were not assessed between the 30 th min and the 2 nd hour, so the exact time of establishment of action of QLB cannot be determined in the present study.…”

Quadratus lumborum Block Reduces Postoperative Opioid Consumption and Decreases Persistent Postoperative Pain Severity in Patients Undergoing Both Open and Laparoscopic Nephrectomies—a Randomized Controlled Trial

“…Quadratus lumborum block (QLB) is a relatively new regional anesthesia technique; it was developed by Blanco [7] and has been proposed as an analgesic alternative for use after many types of surgical procedures [8][9][10]. Several approaches to QLB have been reported [11], but only a few randomized controlled trials (RCT) [4,5,12,13] have evaluated the use of QLB for nephrectomies, all of which concerned laparoscopic procedures. Furthermore, there were differences in the type of block, injection site, and postoperative pain management, and, to our knowledge, none of the RCTs considered QLB following open nephrectomies.…”