Objective To compare the postoperative recovery quality between ultrasound-guided anterior quadratus lumbar block (QLB) and posterior QLB at lateral arcuate ligament after laparoscopic cholecystectomy (LC).

Methods A total of 126 patients with elective LC were selected and randomly divided into QLB at lateral arcuate ligament combined with general anesthesia group (group Q), posterior QLB combined with general anesthesia group (group W), and combined intravenous-inhalation anesthesia group (group K), with 42 cases in each group. At 30 minutes before induction of general anesthesia, group Q was given bilateral QLB at lateral arcuate ligament, group W was given bilateral posterior QLB, and group K was not given block. The score of the 40-item Quality of Recovery (QoR-40) at 24 hours after operation, the scores of the Visual Analog Scale (VAS) at resting and moving states at the time points of immediately after extubation and 2, 4, 8, 12 and 24 hours after operation, the time to the first walk, the time to the first anal exhaust, the number of remedial analgesia, and the incidence of adverse reactions at 24 hours after surgery were observed in three groups.

Results Compared with the group K, the QoR-40 score at 24 h after operation decreased significantly in the group Q and the group W (P < 0.05); compared with the group W, the QoR-40 score at 24 h after operation decreased significantly in the group Q (P < 0.05); compared with the group K, the VAS scores at resting and moving states at the time points of immediately after extubation and 2, 4, 8, 12 and 24 hours after operation decreased significantly in the group Q (P < 0.05), and the VAS scores at resting and moving states at the time points of immediately after extubation and 2, 4 and 8 hours after operation significantly decreased in the group W (P < 0.05); compared with the group W, the VAS scores at resting and moving states at the time points of immediately after extubation and 2, 4, 8, 12 and 24 hours after operation decreased significantly in the group Q (P < 0.05); compared with the group K, the total incidence rate of adverse reactions at 24 h after operation decreased significantly in the group Q and the group W, and the overall incidence rate of adverse reactions at 24 h after operation in the group Q was significantly lower than that in the group W (P < 0.05); the time to the first walk, the time to first anal exhaust and the number of remedial analgesia in the group Q were significantly lower than those in the group W and the group K (P < 0.05). Conclusion Compared with posterior QLB, ultrasound-guided anterior QLB at lateral arcuate ligament can improve the analgesic effect after laparoscopic cholecystectomy, prolong the analgesic duration, shorten the postoperative recovery time, and improve the recovery quality in the early stage after operation.