Background and aims The radical cystectomy is a complex procedure in elderly patients followed by a delayed return of bowel function, hemodynamic instability, that determined length of stay. the epidural anesthesia is the gold standard but its use could cause neurologic deficits and hemodynamic complication. the ultrasound quatratus lumborum block 1(US-QLB1) is a novel technique that resulted reduce complications and shorter hospitalization.

Methods A 74-year-old, ASA 3 patient scheduled to undergo open radical cystectomy for bladder cancer. After induction of general anaesthesia, with the patient in a hyperlordotic position, we performed US-QLB 1. a curvilinear ultrasound probe was placed posteriorly to the iliac crest and a needle (90 mm Temena) was inserted and 20 ml of 0,25% Levobupivacaine bilateral were injected at the anterolateral border of the quadratus lumborum muscle. Patient received inhalation anesthesia with sevoflurane (MAC 0,8) . After surgery the patient was transferred to intensive care for weaning and monitoring.

Results In the first 48 hours the patient reported prolonged pain relief (NRS < 2). Only 3 g of acetaminophen were administered. No complications and early return of bowel function were recorded.

Conclusions This case suggested that US-QLB 1 could represent a viable alternative to epidural anesthesia for analgesic management postoperative in this surgery.