Ultrasound-Guided Quadratus Lumborum Block: An Updated Review of Anatomy and Techniques

Abstract

Purpose of Review. Since the original publication on the quadratus lumborum (QL) block, the technique has evolved significantly during the last decade. This review highlights recent advances in various approaches for administering the QL block and proposes directions for future research. Recent Findings. The QL block findings continue to become clearer. We now understand that the QL block has several approach methods (anterior, lateral, posterior, and intramuscular) and the spread of local anesthetic varies with each approach. In particular, dye injected using the anterior QL block approach spread to the L1, L2, and L3 nerve roots and within psoas major and QL muscles. Summary. The QL block is an effective analgesic tool for abdominal surgery. However, the best approach is yet to be determined. Therefore, the anesthetic spread of the several QL blocks must be made clear.

Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section — a controlled clinical study

“…In our study by contrast, the LA was deposited according to the original 2007 concept, i.e., from the side of the anterolateral abdominal wall and next to the fascia transversalis, which is QLB I [14,16]. Another important difference between our study and that of Blanco et al, which can affect the outcome of the efficiency of analgesic QLB, was the type, concentration and volume of the LA used.…”

“…There were no published studies evaluating the effectiveness of the QLB I and post-cesarean section until 2014, when the protocol of the clinical trial presented here was developed. According to various studies published since 2015, the QLB and its variants are an effective analgesic tool compared with the TAPB due to the absence of the paravertebral component; a smaller scope of activities; and the possibility of fewer complications [15,16,24].…”

“…Over the next 48 hours, all patients received 1 g of paracetamol iv at constant intervals of time (every 6 hours) and 5 mg of morphine subcutaneously depending on their intensity of pain (NRS > 3), or, on demand with the proviso of a 4-hour administration frequency. Next, the the level of pain intensity was evaluated, only in rest among the newly delivered mothers (using NRS scale 0-10 in which 0 = no pain and 10 = worst pain imaginable) and consecutively after 2,4,8,12,16,20,24,30,36, 42 and 48 hours. At every postoperative time-point the following parameters were measured: sedation (Ramsey scale); nausea, vomiting and itching (0 = none, 1 = mild, 2 = moderate, 3 = severe); the possibility of the free movement of limbs or any other possible side effects.…”

“…A unique component of the QLB is not only that it stops somatic pain but also that it inhibits visceral pain due to the spread of the local anesthetic to the paravertebral space. The analgesic's effectiveness and superiority over TAPB after a C-section from a posterior approach (QLB II) were shown by Blanco [14][15][16]. We hypothesized that QLB type I as part of a multimodal analgesic regimen would result in decreased opioid consumption and improved analgesia in the first 48 hours after a C-section.…”

Bilateral quadratus lumborum block for postoperative analgesia in a Von Hippel-Lindau syndrome patient undergoing laparoscopic radical nephrectomy

“…In view of quadriparesis, because of cervical hemangioblastoma and undergoing laparoscopic nephrectomy, it was decided to give general anesthesia with continuous quadratus lumborum (QL) block on the side of the surgery and single-shot QL block on the opposite side was planned to provide complete postoperative analgesia. [12] After explaining procedure, written and informed consent a night before surgery, she was given tablet lorazepam 1 mg and tablet rantac. All standard American Society of Anesthesiologists monitors and an invasive blood pressure monitoring were taken in operation room.…”