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Quadratus Lumborum Block
Rafael Vazquez, MD; Nicole Z. Spence, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          • Outcomes

            TERMINOLOGY

            • Abbreviations

              • Quadratus lumborum muscle (QLM)
              • Thoracolumbar fascia (TLF)
              • External oblique (EOM)
              • Transversus abdominis muscle (TAM)
              • Rectus abdominis muscle (RAM)
            • Definitions

              • Nerve blockade of ventral rami of low thoracic and upper lumbar spinal nerves as they course superficial to QLM and deep to transversalis fascia
                • Results in analgesia to anterior abdominal wall from L1-L2 and also up to T6
                • Can also be used for anesthesia of hip and pelvis
                • QL-1, QL-2, QL-3 blocks have been described in studies, depending on location of local anesthetic injection
              • Renders anesthesia for 6-12 hours
                • Longer analgesia can be provided with catheter placement
              • Provides primary somatic pain coverage
                • Some visceral coverage can be obtained if local anesthetic spreads medially toward dorsal root ganglion and white rami

            PREPROCEDURE

            • Indications

              • Contraindications

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Equipment Preparation

                      • Procedure Steps

                        • Findings and Reporting

                          • Alternative Procedures/Therapies

                            POST PROCEDURE

                            • Expected Outcome

                              • Things to Do

                                • Things to Avoid

                                  OUTCOMES

                                  • Problems

                                    • Complications

                                      Selected References

                                      1. Aksu C et al: Erector spinae plane block vs quadratus lumborum block for pediatric lower abdominal surgery: a double blinded, prospective, and randomized trial. J Clin Anesth. 57:24-8, 2019
                                      2. Baytar Ç et al: Comparison of ultrasound-guided subcostal transversus abdominis plane block and quadratus lumborum block in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical study. Pain Res Manag. 2019:2815301, 2019
                                      3. Elsharkawy H et al: Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study. Reg Anesth Pain Med. ePub, 2019
                                      4. Elsharkawy H et al: The supra-iliac anterior quadratus lumborum block: a cadaveric study and case series. Can J Anaesth. 66(8):894-906, 2019
                                      5. Salama ER: Ultrasound guided bilateral quadratus lumborum block vs. intrathecal morphine for postoperative analgesia after cesarean section: a randomised controlled trial. Korean J Anesthesiol. ePub, 2019
                                      6. Sato M: Ultrasound-guided quadratus lumborum block compared to caudal ropivacaine/morphine in children undergoing surgery for vesicoureteric reflux. Paediatr Anaesth. 29(7):738-43, 2019
                                      7. Zhu Q et al: Ultrasound guided continuous quadratus lumborum block hastened recovery in patients undergoing open liver resection: a randomized controlled, open-label trial. BMC Anesthesiol. 19(1):23, 2019
                                      8. Ben-David B et al: Quadratus lumborum block in management of severe pain after uterine artery embolization. Eur J Pain. 22(6):1032-4, 2018
                                      9. Krohg A et al: The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: a randomized clinical trial. Anesth Analg. 126(2):559-65, 2018
                                      10. Stuart Green M et al: Transmuscular quadratus lumborum block reduces length of stay in patients receiving total hip arthroplasty. Anesth Pain Med. 8(6):e80233, 2018
                                      11. Yang HM et al: Cadaveric evaluation of different approaches for quadratus lumborum blocks. Pain Res Manag. 2018:2368930, 2018
                                      12. Ueshima H et al: Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. Biomed Res Int. 2017:2752876, 2017
                                      13. Borglum J et al: Ultrasound-guided transmuscular quadratus lumborum blockage. BJA: British Journal of Anaesthesia, Volume 111, Issue eLetters Supplement, 22 April 2013
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Preprocedure

                                          • Procedure

                                            • Post Procedure

                                              • Outcomes

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Quadratus lumborum muscle (QLM)
                                                  • Thoracolumbar fascia (TLF)
                                                  • External oblique (EOM)
                                                  • Transversus abdominis muscle (TAM)
                                                  • Rectus abdominis muscle (RAM)
                                                • Definitions

                                                  • Nerve blockade of ventral rami of low thoracic and upper lumbar spinal nerves as they course superficial to QLM and deep to transversalis fascia
                                                    • Results in analgesia to anterior abdominal wall from L1-L2 and also up to T6
                                                    • Can also be used for anesthesia of hip and pelvis
                                                    • QL-1, QL-2, QL-3 blocks have been described in studies, depending on location of local anesthetic injection
                                                  • Renders anesthesia for 6-12 hours
                                                    • Longer analgesia can be provided with catheter placement
                                                  • Provides primary somatic pain coverage
                                                    • Some visceral coverage can be obtained if local anesthetic spreads medially toward dorsal root ganglion and white rami

                                                PREPROCEDURE

                                                • Indications

                                                  • Contraindications

                                                    • Getting Started

                                                      PROCEDURE

                                                      • Patient Position/Location

                                                        • Equipment Preparation

                                                          • Procedure Steps

                                                            • Findings and Reporting

                                                              • Alternative Procedures/Therapies

                                                                POST PROCEDURE

                                                                • Expected Outcome

                                                                  • Things to Do

                                                                    • Things to Avoid

                                                                      OUTCOMES

                                                                      • Problems

                                                                        • Complications

                                                                          Selected References

                                                                          1. Aksu C et al: Erector spinae plane block vs quadratus lumborum block for pediatric lower abdominal surgery: a double blinded, prospective, and randomized trial. J Clin Anesth. 57:24-8, 2019
                                                                          2. Baytar Ç et al: Comparison of ultrasound-guided subcostal transversus abdominis plane block and quadratus lumborum block in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical study. Pain Res Manag. 2019:2815301, 2019
                                                                          3. Elsharkawy H et al: Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study. Reg Anesth Pain Med. ePub, 2019
                                                                          4. Elsharkawy H et al: The supra-iliac anterior quadratus lumborum block: a cadaveric study and case series. Can J Anaesth. 66(8):894-906, 2019
                                                                          5. Salama ER: Ultrasound guided bilateral quadratus lumborum block vs. intrathecal morphine for postoperative analgesia after cesarean section: a randomised controlled trial. Korean J Anesthesiol. ePub, 2019
                                                                          6. Sato M: Ultrasound-guided quadratus lumborum block compared to caudal ropivacaine/morphine in children undergoing surgery for vesicoureteric reflux. Paediatr Anaesth. 29(7):738-43, 2019
                                                                          7. Zhu Q et al: Ultrasound guided continuous quadratus lumborum block hastened recovery in patients undergoing open liver resection: a randomized controlled, open-label trial. BMC Anesthesiol. 19(1):23, 2019
                                                                          8. Ben-David B et al: Quadratus lumborum block in management of severe pain after uterine artery embolization. Eur J Pain. 22(6):1032-4, 2018
                                                                          9. Krohg A et al: The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: a randomized clinical trial. Anesth Analg. 126(2):559-65, 2018
                                                                          10. Stuart Green M et al: Transmuscular quadratus lumborum block reduces length of stay in patients receiving total hip arthroplasty. Anesth Pain Med. 8(6):e80233, 2018
                                                                          11. Yang HM et al: Cadaveric evaluation of different approaches for quadratus lumborum blocks. Pain Res Manag. 2018:2368930, 2018
                                                                          12. Ueshima H et al: Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. Biomed Res Int. 2017:2752876, 2017
                                                                          13. Borglum J et al: Ultrasound-guided transmuscular quadratus lumborum blockage. BJA: British Journal of Anaesthesia, Volume 111, Issue eLetters Supplement, 22 April 2013