Design: Propensity score-matched registry analysis
Population: 445 adults having elective open ventral hernia repair
Primary outcome: Length of stay and post-discharge opioid use
Effect: Median stay 4 days in both; no opioid use at 30 days 87% TAP vs 90% QL

A propensity-matched analysis of a US hernia quality registry compared 333 patients who had transversus abdominis plane (TAP) blocks with 112 who had quadratus lumborum (QL) blocks for elective open ventral hernia repair, most with myofascial release and retromuscular mesh.

Median stay was 4 days in both groups, and opioid use after discharge was similar (no use at 30 days in 87% with TAP and 90% with QL). Complications and readmissions did not differ. Patients who had QL blocks reported higher pain scores at 30 days on one measure.

The QL block is technically more demanding and is often assumed to give better analgesia. This registry does not support that assumption for open hernia repair.

It is observational and the groups were unequal in size, so a small difference either way cannot be excluded.

A TAP block remains a reasonable default for open ventral hernia repair.
Choose the block your anaesthetic team performs reliably.
Plan multimodal analgesia regardless of block type.
Ask about pain at the 30-day review; scores differed only there.

Why it matters

A harder block did not buy better recovery in this setting.

The statistics, in plain English

Propensity matching makes groups similar on measured factors but cannot balance unmeasured ones. A finding of no difference in a study this size means large differences are unlikely, not that the blocks are identical.