Comparing quadratus lumborum and transversus abdominis plane blocks for pain control after open ventral hernia repair: a propensity score-matched analysis of the Abdominal Core Health Quality Collaborative

Introduction Transversus abdominis plane (TAP) blocks are commonly used to reduce postoperative pain after ventral hernia repair (VHR). However, quadratus lumborum (QL) blocks may provide improved pain control. While TAP blocks have been studied in VHR, no literature directly compares TAP and QL blocks for open VHR. Methods A propensity score-matched analysis of the Abdominal Core Health Quality Collaborative (ACHQC) was performed for patients undergoing elective open VHR between January 2023 and July 2025 who received TAP or QL blocks. Outcomes included length of stay (LOS), post-discharge opioid use, patient-reported pain and quality of life, and 30-day complications and readmissions. Results After matching, 445 patients met inclusion criteria: 333 (75%) received TAP blocks and 112 (25%) received QL blocks. Median age was 62 years, and median BMI was 32 kg/m 2 . Most patients underwent myofascial release with retromuscular mesh placement. Hernia width was similar between groups (11 vs 12 cm, p = 0.6). Median LOS was 4 days in both groups ( p = 0.07). At 30 days, 87% of TAP and 90% of QL patients reported no opioid use after discharge ( p = 0.5). HerQLes scores were similar, but PROMIS-3a pain scores were higher in QL patients at 30 days ( p = 0.006). Complications and readmissions were similar. Conclusion This is the first study to compare the outcomes of QL and TAP blocks for patients undergoing open VHR. There was no difference in pain control between each group as measured by hospital LOS and post-discharge opioid consumption; however, QL block patients reported higher pain scores at 30 days.