Quadratus Lumborum Vs Ilioinguinal

Updated: Aug 2, 2023

While most people grab a good book to relax before slipping off into that nighttime coma we seek after a hard day at work, for me a good read is finding published articles that answer my endless questions. Most recently the question has been which regional block and why? I started with the ilioinguinal and quadratus lumborum.

My research led me in two different directions. I started with article one (below) and could have stopped there with a satisfactory answer to my question, but it led me down that rabbit hole where I quickly found article two. I closed this book (articles) with the thought that there are always 2 sides to every story and seldom leads to a clear and direct answer. So I thought I would turn to you for your opinion.

Article one, Ilioinguinal/Iliohypogastric versus quadratus lumborum nerve blockade for elective open inguinal herniorrhaphy: a prospective, randomized, double-blinded, equivalency trial

This study included a randomized group to preoperatively receive either an IINB or a transmuscular QLB with 0.25% bupivacaine/epinephrine/clonidine for postoperative analgesia. Outcomes included resting NRS pain scores at 8 and 24 hours, movement NRS pain scores at 24 hours, incidence of opioid related side effects (nausea, vomiting, pruritus), time-to-first oral opioid analgesic, and total opioid consumption at 24 hours.

This study concluded an IINB and a transmuscular QLB are equivalent with regards to their ability to provide postoperative analgesia after OIH

Article two, Ultrasound-guided quadratus lumborum block versus ilioinguinal–iliohypogastric nerve block with wound infiltration for postoperative analgesia in unilateral inguinal surgeries: A randomised controlled trial

This study included Group QL received 20 ml of inj. ropivacaine 0.5% while patients in Group IL received 10 ml of inj. ropivacaine 0.5% at the ilioinguinal–iliohypogastric nerve site and 10 ml of inj. ropivacaine 0.5% that was locally infiltrated at the surgical site. Duration of analgesia, Visual Analogue Scale (VAS) score, total requirement of analgesic dosage in the first 24 hours, and patient satisfaction score were compared in both the groups.

This study concluded that US-guided QL block significantly prolongs the duration and quality of postoperative analgesia, thereby reducing analgesic consumption and increasing overall patient satisfaction.