Quadratus Lumborum Blocks in Nephrectomy: A Narrative Review

Abstract

The quadratus lumborum block is a novel truncal block where local anaesthetic is injected adjacent to the quadratus lumborum muscle. It is used for caesarean sections, hip arthroplasty, gynecologic surgery, colectomy, and recently nephrectomy. To date, there are no reviews that outline the efficacy and performance of the quadratus lumborum blocks in patients receiving laparoscopic nephrectomy. The objective of this project was to outline the current available data from both clinical trials along with case series and reports regarding the methods and utility of quadratus lumborum blocks for analgesia in patients receiving nephrectomy. For this literature review, we searched Pubmed, Embase, and Web of Science from their inception until 5/31/2020. Our search terms were as follows: "(nephrectomy OR laparoscopic nephrectomy) AND (QL block OR Quadratus Lumborum block OR QL OR TQL OR Thoracolumbar fascia block)." We analyzed all relevant clinical trials for quality using the Jadad scale. Our search yielded a total of 30 articles, 23 of which we ultimately reviewed for this manuscript. The qualitative sum of these data show that patients receiving quadratus lumborum block for nephrectomies have reduced opioid requirements, reduced pain scores, and improved side-effects relative to other analgesic modalities like epidurals. Based on these findings, we conclude that the quadratus lumborum block is a useful analgesic for patients undergoing nephrectomy.

Keywords: laparoscopic nephrectomy; peripheral nerve block; postoperative pain; quadratus lumborum block; regional anesthesiology.

Figure 1

The relevant anatomy and needle trajectory (gray line) for the three major types of quadratus lumborum blocks. Image (A) shows the anterior (TQL) QLB block with the needle path coming posterior to anterior. Image (B) shows the lateral (QL1) QLB. Image (C) shows the posterior (QL2) QLB.

Figure 2

Two common locations for trocar placement and extraction incisions seen in laparoscopic nephrectomies.