Comparison of Quadratus Lumborum Block and Transversus Abdominis Plane Block for Postoperative Pain Management

Abstract

Enhanced recovery after surgery (ERAS) protocols have been developed to promote rapid recovery of patients who undergo certain major surgeries, throughout the perioperative continuum, with a variety of interventions. Many protocols for open abdominal cases suggest preoperative epidural, wound catheter, or transversus abdominis plane (TAP) block placement for postoperative pain management.¹ This case study presents a middle-aged woman who underwent a pancreatoduodenectomy (PD) and received an alternate postoperative fascial plane block, a quadratus lumborum (QL) block, rather than the currently recommended TAP block, wound infiltration, or neuraxial anesthesia.  Considering established ERAS protocols, the purpose of this case study is to examine the use of alternative forms of regional anesthesia for open abdominal cases, specifically the quadratus lumborum (QL) block, and compare it to the currently recommended TAP block.

Based on quality evidence regarding the benefits of the QL block, expanding ERAS protocols to regional anesthesia beyond wound infiltration and TAP blocks has the potential to produce increased pain management postoperatively, aiding in enhanced recovery and improved outcomes. Future, high-quality research should be initiated spanning a larger, more generalized population, including ASA III and IV, with BMIs not limited to 30 kg/m², to confirm current study’s findings.  Further evaluation of the local anesthetic’s diffusion via the TLF and the adjacent paravertebral space should be studied, due to the inquiries of the QL block’s definite mechanism of action that remain.  Regarding the variation in fascial layers and dermatomes covered based on the type of QL block, further studies examining QL block injection sites should be considered.