To compare the postoperative analgesic effect of two ultrasound guided approaches of quadratus lumborum block (QLB) (anterior and intramuscular) for radical cystectomy.

The quadratus lumborum block (QLB) is one of the abdominal wall block techniques used to anesthetize thoracolumbar nerves . The QLB technique was described initially by Blanco et al. in 2007 (not published), then reported initially by Kadam in 2013. Since then, QLB has evolved with the development of the ultrasound-guided nerve block. To date, several randomized controlled trials have reported effective postoperative analgesia, with non-intramuscular QLB for cesarean sections, laparoscopic gynecologic surgery and hip hemiarthroplasty .

The intramuscular QLB (QLBi) technique was first reported by. This approach is different from others in tubouchi for QLB; although the injection target sites of the other approaches are planes around the quadratus lumborum muscle, the intramuscular approach penetrates the fascia of the quadratus lumborum muscle, where local anesthetics are injected. Therefore, QLBi is relatively easier to perform compared with other QLB approaches.

The incidence of urinary bladder cancer in the Middle East and Africa is greater in areas with high rather than low SH prevalence.

Inclusion Criteria:

• Age: 40-70years.

  • BMI: 20-30 kg.m2
  • Sex: both males and females.
  • American Society of Anesthesiologists (ASA )physical status: I-III.
  • Operation: radical cystectomy

Exclusion Criteria:

• • Patient's refusal to participate in the study.

  • known allergy to local anesthesia (LA),
  • coagulopathy or thrombocytopenia,
  • body mass index (BMI) above 30 kg .m 2, and infection at site of injection.
  • Chronic pain syndromes,
  • Prolonged opioid medication,
  • Patients on regular use of analgesic or who received analgesic 24 h before surgery