Newly Published
Clinical Focus Review  |   December 2018
Quadratus Lumborum Block: Anatomical Concepts, Mechanisms, and Techniques
Author Notes
  • From the Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (H.E.); Department of Anesthesiology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio (H.E.); Department of Anaesthesia, Guy’s and St. Thomas’ National Health Service Foundation Trust, London, United Kingdom (K.E.-B.); King’s College, London, United Kingdom (K.E.-B.); Department of Anaesthesia and Acute Pain Medicine, St. Vincent’s Hospital, Melbourne, Australia (M.B.); and Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (M.B.).
  • Submitted for publication April 12, 2018. Accepted for publication October 18, 2018.
    Submitted for publication April 12, 2018. Accepted for publication October 18, 2018.×
  • Correspondence: Address correspondence to Dr. Elsharkawy: Department of Anesthesiology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, 9500 Euclid Avenue, E-31, Cleveland, Ohio 44195. elsharh@ccf.org. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Pharmacology / Clinical Focus Review
Clinical Focus Review   |   December 2018
Quadratus Lumborum Block: Anatomical Concepts, Mechanisms, and Techniques
Anesthesiology Newly Published on December 21, 2018. doi:10.1097/ALN.0000000000002524
Anesthesiology Newly Published on December 21, 2018. doi:10.1097/ALN.0000000000002524
Ultrasound-guided quadratus lumborum block is a recently described fascial plane block where local anesthetic is injected adjacent to the quadratus lumborum muscle with the goal of anesthetizing the thoracolumbar nerves. The objective of this article is to review the relevant anatomy, potential mechanisms, approaches, and techniques and summarize the clinical evidence for quadratus lumborum block.
Quadratus lumborum is a posterior abdominal wall muscle that originates from the posteromedial iliac crest and inserts into the medial border of the twelfth rib and the transverse processes of the first to fourth lumbar vertebrae. The lateral free border of quadratus lumborum is angled from craniomedial to caudolateral (fig. 1A). The quadratus lumborum and psoas major muscles traverse posterior to the lateral and medial arcuate ligaments of the diaphragm, respectively (fig. 1B). Posterior to the quadratus lumborum muscle lies the erector spinae muscle group, consisting of the multifidus, longissimus, and iliocostalis (figs. 2 and 3).