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Decoding quadratus lumborum blocks: Fascial pathways and analgesic coverage-A narrative review
Kartik Sonawane1, Tuhin Mistry1
1Consultant, Department of Anaesthesiology and Perioperative Care, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, India.
Indian Journal of Anaesthesia
|February 16, 2026
Summary
Quadratus lumborum blocks offer abdominal analgesia, but variability exists. Understanding fascial anatomy and ultrasound correlations improves injectate spread, enhancing precision and safety for better pain management.
Area of Science:
- Anesthesiology
- Anatomy
- Regional Anesthesia
Background:
- Quadratus lumborum blocks provide abdominal wall analgesia via thoracoabdominal and lumbar pathways.
- Outcome variability persists due to incomplete understanding of fascial continuities and neural trajectories.
Purpose of the Study:
- To synthesize foundational anatomy, cross-sectional relationships, and ultrasound correlations for quadratus lumborum blocks.
- To explain injectate spread and guide precise block techniques for improved clinical outcomes.
Main Methods:
- Narrative review of cadaveric dissections, radiologic studies, and live sonoanatomy.
- Mapping the three-dimensional interplay of muscles, fascial planes, and nerves at the T12-L1 transition.
Main Results:
- Anterior/transmuscular approaches better access paravertebral and lumbar plexus, while superficial/lateral techniques target flank coverage.
- Quadratus lumborum block is framed within a continuous fascial network, aiding target selection and volume planning.
Conclusions:
- Precise sonoanatomy and understanding fascial planes enhance quadratus lumborum block reproducibility and safety.
- This framework facilitates matching block variants to surgical needs for predictable, opioid-sparing analgesia.
Keywords:
Abdominal musclesQL blockabdominal wallanalgesicsfascial plane blockquadratus lumborumregional anaesthesiaregional analgesiatransmuscular approachultrasoundMore Related Videos
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