Background: The ultrasound-guided quadratus lumborum block (QLB) is a well-established procedure for administering local anesthetic to the abdominal wall. By injecting the anesthetic from the posterior abdomen, it effectively spreads across the quadratus lumborum muscle as well as blocks the intermuscular nerves.

Objectives: The objective is to examine the impact of three distinct practical ways for quadratus lumborum block, specifically type 2 and 3, as well as their combination.

Methods: This is a prospective cohort study performed on eighty participants, all were followed at the obstetrics & gynecology units at the Faculty of Medicine of Sohag University. According to pre-settled protocol in our hospital, patients who request post CS analgesia are assigned to one of four distinct types of post operative analgesia: Epidural analgesia (EA) only group, the QLB type 2 plus EA, QLB type 3 plus EA, QLB type 2 + 3 plus EA.

Results: Assessment of pain was performed in all groups by using the VAS at rest and with movement during the 1st 48 hours after CS and it revealed that pain was lower in the EA only group in comparison to QL groups at rest and in between the QL groups, pain was lower in the QL (2+3) group than QL3 group and QL2 group reported the highest VAS at rest.

Conclusion: In conclusion, spinal morphine and different QL block approaches can alleviate post CS pain, in addition, QL (2+3) approach is the most effective strategy for pain management with minimal side effects and complications.