Authors: Rytel H et al.
Cureus 17(7): e88051 DOI: 10.7759/cureus.88051
The quadratus lumborum block (QLB) has evolved into one of the most promising regional anesthetic techniques for abdominal and pelvic surgery. Unlike TAP blocks that provide only somatic analgesia, QLB enables both somatic and visceral pain relief due to spread of local anesthetic along the thoracolumbar fascia and, in some approaches, into the thoracic paravertebral space. Multiple QLB approaches exist (QLB-1, QLB-2, QLB-3, QLB-4), each differing in fascial plane targets, spread, and clinical utility. QLB-2 and QLB-3 appear to provide the broadest and longest-lasting analgesia.
Across numerous studies, QLB has consistently reduced postoperative pain scores, opioid consumption, and hospital stay duration after cesarean delivery, colorectal surgery, laparoscopic procedures, hip surgery, and pediatric urologic operations. Compared with epidural analgesia, QLB offers fewer hemodynamic effects, simpler placement, and lower complication rates while still providing visceral coverage. Improvements in ultrasound imaging have further enhanced block accuracy and safety.
Despite these advantages, some limitations remain: variability in anesthetic spread, the need for technical ultrasound proficiency, and inconsistencies in outcomes between different QLB techniques. Standardization of volume, approach, and training is a priority for expanding its clinical adoption. Early evidence for future techniques—such as the quadro-iliac plane block—suggests even broader potential coverage but requires further study.
The review concludes that QLB provides reliable, opioid-sparing abdominal analgesia with fewer side effects than many existing regional techniques. With appropriate training and integration into ERAS pathways, QLB is positioned to become the next major standard for abdominal wall analgesia.
What You Should Know
• QLB provides both somatic and visceral analgesia, unlike TAP blocks.
• QLB-2 and QLB-3 deliver the widest dermatomal coverage.
• Consistently reduces opioid use, pain scores, and length of stay after many abdominal and pelvic surgeries.
• Safer and less invasive than epidural analgesia with fewer hemodynamic concerns.
• Requires ultrasound skill; variability in spread remains the main limitation.
• Strong emerging role in ERAS protocols and pediatric anesthesia.
• Likely to become a primary abdominal wall block as standardization improves.
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