Background: The incidence of postoperative complications increases with the uncontrolled pain in abdominal surgeries. One of the most recent effective pain management for these procedures is the quadratus lumborum block (QLB). Blanco first described it in 2007 and it has been performed as a perioperative pain control in pediatrics, pregnant and adults. With the purpose of reducing hospital time, financial costs and to maintain effective treatments, the aim of this case series is to discuss the QLB-type II technique as a regional anesthesia for laparoscopic inguinal hernia repair.
Case Report: Four patients were submitted to QLB-type II for totally extraperitoneal laparoscopic inguinal hernioplasty. They were sedated with fentanyl 1.0-1.5 mcg/kg and continuous infusion of propofol. In sequence, they had the contralateral site blocked by semilunar (SML) technique for insertion of the optic surgical trocater. The blockages were guided by ultrasound of high-frequency linear probe and provided with ropivacaine 0.5%(ROP) using a Whitacre needles. The multimodal analgesia was conducted with magnesium sulfate 40mg/kg and ketamine 0.2mg/kg. Case 1: Male, 50 years old, 78 kg, ASAIII, 25mL of ROP for QLB and 10mL for SML. Case 2: Male, 42 years old, 64kg, ASAII, 20mL of ROP for QLB and 10mL for SML. Case 3: Female, 47 years old, 50 kg, ASA I, 20mL of ROP for QLB and 10mL for SML. Case 4: Male, 14 years old, 60kg, ASAI, 18mL of ROP in each side for bilateral QLB. All patients evolved with no complications or pain complaints postoperatively and they were discharged from hospital 6 hours after the surgery.
Discussion: In the QLB, the local anesthetic is distributed adjacent to the anterolateral border of the quadratus lumborum muscle. The advantages of this technique include the reliable distribution in the abdominal cavity, the wide sensory blockage (T6-L1) and visceral and abdominal wall analgesia. In addition, the QLB can be recommended to reduce the necessity of general anesthesia and to be used as the main component of multimodal analgesia postoperatively.
Learning points: The QLB has the potential to reduce the hospital time, the financial costs and to provide effective analgesia for abdominal surgeries. There are few randomized trials and no study reporting complications associated with the QLB.

06 / Quadratus lumborum block for laparoscopic inguinal hernia repair: case series.