Esra Turunc

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The anterior quadratus lumborum block (aQLB) is a fascial plane block targeting the interfascial plane between the quadratus lumborum and psoas major muscles, aiming to achieve both somatic and visceral analgesia through potential spread of local anesthetic toward the thoracolumbar nerve roots. Despite years of clinical use and a growing body of randomized trials across different surgical settings, uncertainty remains regarding its mechanisms of action, patterns of local anesthetic spread, and overall clinical effectiveness. This scoping review aimed to systematically map and synthesize the available evidence on aQLB and identify key knowledge gaps relevant to clinical practice and future research. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from database inception to February 14, 2026. The search terms included variations of aQLB and related terminology. Only randomized controlled trials were included in this review. A total of 1174 records were identified, of which 360 underwent full-text assessment, and 119 randomized controlled trials were included. Most studies were conducted in Asia (63%) and involved adults (92%). Abdominal and urological procedures were the most commonly studied surgical indications (56%), followed by orthopedic surgeries (26%) and obstetric-gynecological procedures (17%). Multiple aQLB variants have been reported, including transmuscular, subcostal anterior, supra-arcuate ligament, and lateral arcuate ligament approaches. Comparators included sham or no block, wound infiltration, transversus abdominis plane block, erector spinae plane block, paravertebral block, neuraxial techniques, and other regional techniques. Across studies, the aQLB generally reduced postoperative pain scores, opioid consumption, and postoperative nausea and vomiting. However, the findings were heterogeneous and varied by surgical procedure and study design. The available literature suggests that aQLB may provide effective postoperative analgesia and opioid-sparing benefits across different surgical procedures. However, inconsistent findings among studies, the limited number of well-designed randomized controlled trials, and substantial heterogeneity across surgical populations restrict the strength of the current conclusions. Moreover, the deep anatomical location of the block, technical complexity, and potential risks should be considered when evaluating its role in routine clinical practice.

Despite recent advancements, ensuring the successful placement and safe ventilation of second-generation supraglottic airway devices (SAD) remains challenging, particularly in pediatric patients. This study aims to compare three LMA ProSeal insertion techniques to assess their impact on placement effectiveness in children, as measured by oropharyngeal leak pressure (OLP). This study hypothesized that different insertion techniques would have a statistically significant effect on OLP in pediatric patients. This was a prospective, randomized, controlled trial conducted at a single-center university hospital from October 2023 to April 2024. A total of 150 children aged 1-10 years undergoing short surgical procedures (≤90 minutes) were enrolled. After inserting the LMA ProSeal via standard technique (SD group), direct laryngoscopy (DL group), or videolaryngoscopy (VL group), OLP was measured by detecting air leaks at the thyroid cartilage while closing the valve up to 30 cmH2O. A fiberoptic bronchoscope was used to evaluate the glottic view. Of the 159 screened patients, 150 were analyzed per protocol. OLP was significantly higher in the VL group (median [Q1-Q3], 26 [24.2-27] cmH2O) compared to the DL group (23 [21.2-24] cmH2O) and SD group (21 [20-22] cmH2O) (P<0.001). The DL group showed significantly higher OLP than the SD group (P=0.001). Fiberoptic imaging scores were higher in the VL group than in the other groups (P<0.001). The first-attempt success rate of SAD insertion was comparable between the VL and DL groups (94% each), but lower in the SD group (86%) (p=0.290). The SAD insertion time was significantly longer in the VL and DL groups compared to the SD group (median [Q1-Q3], 21 [19.2-22] s; 21 [19-22] s; 14 [13-16] s respectively, P<0.001), although there was no significant difference between VL and DL. The number of additional maneuvers during SAD placement was similar between the VL and DL groups but lower in the SD group (P=0.008). Videolaryngoscopy resulted in the highest OLP and the best fiberoptic views, ensuring superior SAD placement. Direct laryngoscopy improved placement over the standard technique but was less effective than videolaryngoscopy.

Background Postoperative pain after laparoscopic colorectal surgery (LCS) is complex, involving both somatic and visceral components. Anterior subcostal quadratus lumborum block (QLB) is a novel regional technique that may provide dual analgesic coverage. Objective To evaluate the analgesic efficacy of ultrasound-guided anterior subcostal QLB in patients undergoing LCS. Design This prospective, randomized, observer-blinded trial included 60 adults scheduled for elective LCS at a university hospital between October 2024 and May 2025. Patients were randomly allocated to receive either bilateral anterior subcostal QLB or no regional anesthesia or local anesthetic infiltration (control). Main outcome measures The primary outcome was cumulative intravenous morphine milligram equivalent consumption at 24 hours postoperatively. Secondary outcomes included 12 hours intravenous morphine milligram equivalent consumption, pain scores (at rest and activity), time to first demand for patient-controlled analgesia (PCA), rescue analgesic/antiemetic use, block-related complications and recovery parameters. Results Data from 55 patients were analyzed (QLB (n=27); control (n=28)). The median 24-hour intravenous morphine milligram equivalent consumption was significantly lower in the QLB group than that in the control group (15 mg (Q1–Q3, 6.5–22 mg) vs 24.3 mg (Q1–Q3, 20.3–30.3 mg); p=0.006). Pain scores at all time points were significantly lower in the QLB group (pConclusions The anterior subcostal QLB was associated with reduced postoperative opioid use, lower pain scores and a lower incidence of postoperative nausea–vomiting after LCS, suggesting a potential role in enhancing recovery. Trial registration number NCT06653439; registration date: 20 October 2024.