The use of the quadratus lumborum block (QLB) resulted in an increased sensory block (T6-L1) compared to the TAP block when performed using a similar volume of local anesthetic [22]. For this reason, QLB is very interesting for upper abdomen midline defects. We can use the same principle of TAP block to understand the application of this technique in video-laparoscopic surgeries when adding analgesia to higher regions of the abdomen.

The QLB is a superficial fascial block between the posterior abdominal wall muscles and is not technically difficult to perform. This technique has three different approaches. We suggest the use of type 2 because it is safe and easy to perform. Although it can be performed with the patient supine, the lateral decubitus position is preferred for two reasons : stability in handling the ultrasound probe and needle, and increased patient comfort (Figs. 4 and 5).

The probe is placed in the anterior axillary line to visualize the typical triple abdominal layers. Then the probe is placed in the mid-axillary line. At this juncture , the abdominal layers start to taper. When the probe is placed in the posterior axillary line, sonoanatomy first shows the transversus abdominis disappearing followed by both the internal and external obliques, which form an aponeurosis. Finally, the appearance of QL is noticed. At the junction of the tapered ends of abdominal muscles and the QL, a needle is inserted in the plane.

Because this is a fascial plane block, it requires a large volume of local anesthetic to obtain a reliable block similar to other blocks of its kind. Volumes of 20–30 mL are usually recommended. The block onset time depends on a number of factors, including but not limited to vascularity of the area, the exact tissue plane where the local anesthetic was injected, as well as type and concentration of local anesthetic used.