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Background and Aims Myasthenia gravis (MG) is an autoimmune disease caused by antibodies against postsynaptic acetylcholine receptors. It is characterized by muscle weakness and fatigability, and patients are at high risk of respiratory failure during anesthesia. We present a 69-year-old male patient with a history of diabetes, hyperlipidemia and coronary artery disease, who had a myocardial infarction six months ago and has been diagnosed with myasthenia gravis for 19 years. The patient presented with ptosis in the left eyelid, muscle weakness in both upper and lower left extremities, and an inability to walk. His medications included pyridostigmine, empagliflozin, acetylsalicylic acid, and atorvastatin. Due to an acute calculous cholecystitis episode accompanied by elevated CRP and leukocytosis, a percutaneous cholecystostomy drain was planned by interventional radiology, and anterior QLB was administered for analgesia.Methods The patient was placed in the left lateral decubitus position, and under ultrasound guidance with low frequency curve probe, a 12 cm needle was inserted between the quadratus lumborum and psoas major muscles. After saline injection we confirm the neddle placement and 20 cc of 0.25% bupivacaine was administered.Results Ten minutes after the block, a pinprick test confirmed the absence of pain sensation between the T4 and T10 dermatomes. Visuel analouge scale was under 4 during procedure. The patient remained hemodynamically stable during the procedure (heart rate: 80 bpm, blood pressure: 131/73 mmHg, SpO 2: 97%), with no need for additional analgesia or sedation.Conclusions The anterior quadratus lumborum block provides broad dermatomal analgesia through cephalad spread and may also be effective for visceral pain due to its proximity to the rami communicantes. For patients with myasthenia gravis undergoing interventional cholecystostomy, an anterior quadratus lumborum block provides a safer and more selective analgesic alternative, as it prevents the risk of respiratory failure.