A Review of the Quadratus Lumborum Block and ERAS

Michael Akerman, Nada Pejčić, Ivan Veličković, Michael Akerman, Nada Pejčić, Ivan Veličković

Abstract

The use of truncal nerve blocks has been described since 2001. Since then, there have been many studies trying to understand the ideal clinical scenarios for its use. Since 2001, the transversus abdominis plane block has evolved in many ways including from landmark based technique to ultrasound guided and more recently, into the quadratus lumborum (QL) block. Its anatomical placement, concentration of local anesthetic, volume of local anesthetic, and anatomic placement have all been raised as clinical questions. This article will discuss the literature of the QL block in an effort to understand how it is best used in a variety of clinical scenarios.

Keywords: quadratus lumborum; quadratus lumborum block; transversus abdominis plane block; truncal block; ultrasound.

Figures

Figure 1
Figure 1
Cross-section of the abdomen—a photo of cadaver and a scheme of anatomical structures. QLB 1—point of local anesthetic (LA) injection for QLB 1; QLB 2—point of LA injection for QLB 2; QLB 3—point of LA injection for QLB 3; 1—rectus abdominis muscle; 2—external oblique muscle; 3—internal oblique muscle; 4 –transversus abdominis muscle; 5—psoas major muscle; 6—quadratus lumborum muscle; 7—erectores spinae muscle; 8—lamina posterior of the thoracolumbar fascia; 9—lamina media of the thoracolumbar fascia; 10—lamina anterior of the thoracolumbar fascia; 11—latissimus dorsi muscle.
Figure 2
Figure 2
Muscles of the anterolateral abdominal wall.
Figure 3
Figure 3
Quadratus lumborum type 1 block—needle position.

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