Quadratus lumborum block: an effective method of perioperative analgesia in children undergoing pyeloplasty

A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers

“…The needle is advanced in an anterior-to-posterior direction and injectate spread occurs over the anterior aspect of the quadratus lumborum muscle. Again, its efficacy is supported in a case report [17]. Børglum et al [6] subsequently described the transmuscular quadratus lumborum approach, also called an anterior QL block, in which the plane between quadratus lumborum muscle and transversalis fascia is reached by advancing the needle in a posterior-to-anterior direction through the quadratus lumborum muscle.…”

“…Børglum et al [6] subsequently described the transmuscular quadratus lumborum approach, also called an anterior QL block, in which the plane between quadratus lumborum muscle and transversalis fascia is reached by advancing the needle in a posterior-to-anterior direction through the quadratus lumborum muscle. Again, its efficacy is supported in a case report [17]. Finally, Blanco and McDonnell [9] have recommended a modification of the lateral (QL1) approach (the posterior quadratus lumborum block -which they termed the 'QL2' quadratus lumborum block, a posterior QL block) in which an injection is made on the posterior (dorsal) aspect of the quadratus lumborum muscle instead of on the ventral aspect.…”

Essentials of Our Current Understanding

“…The early descriptions exist primarily as conference abstracts and e-letters, and most of our knowledge comes from case reports. 39,200,[203][204][205][206] Blanco et al 207 recently published the first RCT of the QL2 block and demonstrated that when added to a multimodal analgesic regimen of acetaminophen and NSAIDs (but no intrathecal morphine) in patients undergoing elective cesarean delivery it reduced opioid requirements and pain scores in the first 24 to 48 hours. In another study, Murouchi et al 49 compared a prospective cohort of 11 patients undergoing laparoscopic gynecologic surgery who received bilateral QL2 blocks to a historical cohort of patients who received bilateral TAP blocks.…”

The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia

“…However, most pediatric surgical interventions do not merit the use of these more complicated and resource-demanding options for postoperative analgesia. 49,50 Thus, a popular alternative to achieve prolongation of a single-injection nerve block is to use adjuvant drugs that are mixed with the LAs and thereby increase the duration of the nerve block. 51,52 Advantages associated with the use of adjuvant drugs include (1) prolong block duration and analgesic effect, (2) reduce general anesthetic requirement, (3) allow for a smooth emergence from anesthesia and a calm recovery room stay, (4) reduce the incidence of emergence delirium and shivering, (5) provide a comfortable early postoperative period in the context of ambulatory surgery that will allow early discharge from the hospital and a pain-free transfer back home.…”