Quadratus Lumborum Blocks: A Brief Update about Clinical Effectiveness from SPA Member Survey Responses

By Franklin Chiao, MD
New York Presbyterian Medical Center-Weill Cornell Medicine

Last year, Chiao and colleagues described the technique for a relatively new truncal block in pediatrics1.  We describe the results from a survey of members regarding use of QLB in clinical practice.  

Survey respondents reported that the majority have used a quadratus lumborum block (QLB) at least once (Figure 1). 

Fig 1
Figure 1: Have you used the quadratus lumborum block before?

For more extensive vertical incisions, they accurately identified the QLB as the technique that may be more effective because of the larger dermatomal coverage (Figure 2).  QLB may cover from T7 to L1. 

Fig 2
Figure 2: If a patient were to undergo a surgery requiring an incision from T7 to L1, and you had to choose between TAP blocks and QLB, which would you choose?

Half of respondents found that a QLB provides very good analgesia and most thought it was better than a transversus abdominis plane (TAP) block, but only about 1/3 thought it worked more reliably than a TAP block (Figure 3). 

Fig 3

Figure 3: If you have placed QLB, how has your experience been?

It seems then that perhaps TAP block is not as effective as the QLB block, but reliability may be similar.  This would seem to be similar to the findings of a recent paper in Regional Anesthesia and Pain Medicine by Oksuz which described lower pain scores 24 hours post-operatively in the QLB group compared to the TAP block group2.  

With regards to the type of QLB, most respondents found that QLB type 2 works best (Figure 4).

Fig 4

Figure 4: Which type of QLB do you think works best?

The best type of QLB is still a point of contention as use among practitioners varies.

References:

  1. Chiao F, Jung, B. Quadratus Lumborum Block: A More Extensive Spread and Longer-Lasting Alternative to the Tranversus Abdominus Plane Block? SPA Volume 29, Number 3, 2016 http://www2.pedsanesthesia.org/newsletters/2016fall/Quadratus.ht.
  2. Öksüz G1, Bilal B, Gürkan Y, Urfalioğlu A, Arslan M, Gişi G, Öksüz H. Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Children Undergoing Low Abdominal Surgery: A Randomized Controlled Trial. Reg Anesth Pain Med. 2017 Jul 27.

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