American Society of Regional Anesthesia and Pain Medicine May 2018 - 27
Figure 1: Targets of the transversus abdominis plane and quadratus lumborum blocks.
and originally published as the "posterior TAP block" technique.
With the evolution of nomenclature, the current description of
the QLB1 should be considered deep to the TA aponeurosis while
the posterior TAP block is superficial.15 Additional ultrasoundguided approaches, including the QL2 and QL3 block, have been
described in the November 2015 issue of ASRA News.16 The QL2
block, or injection between the posterior border of the QL muscle
and the erector spinae, dissects the plane toward the midline and
blocks the ilioinguinal, iliohypogastric, and subcostal nerve fibers.
In addition, blocking the sympathetic nerve fibers that cover the
thoracolumbar fascia sublayer has theoretical benefit. Future
investigation is required for further conclusions regarding the
optimal approach.
The QLB is a novel and promising technique and is currently used
at both authoring institutions. However, opportunities for future
investigation exist because few randomized controlled trials have
examined the QLB in this patient population. What has been shown
is that patients who received a QLB, compared to placebo, and
undergoing elective Cesarean section were able to reduce their
total morphine consumption by more than 40% within the first 12
hours, and overall fewer patient-controlled analgesic demands
were required throughout the 48 hours post delivery.6 When
comparing the QLB to the TAP block in a similar patient population,
Figure 2: The transversus abdominis plane block provides a sensory
and motor block from approximately T10-L1.
the QLB outperformed the TAP block by significantly reducing
morphine consumption at 12 (37.5%), 24 (55%), and 48 (48%)
hours post delivery.17
American Society of Regional Anesthesia and Pain Medicine
2018
27
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