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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionBackground and Aims The anterior approach of Quadratus Lumborum Block (QLB-A) is a promising alternative to thoracic epidural analgesia (EA). Despite being the gold standard, EA is associated with complications. This study aims to compare the efficacy of QLB-A and EA in pain management in open colorectal surgeries.Methods Totally, 10 patients undergoing laparotomic hemicolectomies with general anaesthesia were comparable (ASA II-III) and analysed when QLB-A was performed (6 patients) as a part of a multimodal analgesia or receiving EA (4patients). QLB-A patients in the lateral decubitus position received bilateral injections of 30 ml of 0.25% bupivacaine preoperatively with Paracetamol and Dexketoprofenum after surgery. EA patients were standardized at the Th9/10 level, with an initial of 7 ml 0.25% bupivacaine followed by a continuous infusion of 0.125% bupivacaine at 5 ml/h. As a primary outcome pain scores at rest and with activity were compared at 2, 6, 12 and 24 hours (h) postoperatively, secondary opioid consumption and time to the first opioid requirement.Results Our preliminary data show that at 2 h, QLB-A demonstrated lower pain scores at rest (median 1.17 vs. 2.83, p<0.05) and with activity (median 2.00 vs. 4.83, p<0.05) compared to EA . At 6 h, QLB-A continued to show lower pain scores at rest (median 2.00 vs. 3.00, p=0.10) and with activity (median 3.33 vs. 4.33, p=0.10). By 12 h, pain scores were comparable, with both reporting a median pain score of 2.33, p=0.5 at rest and 4.00, p=0 with activity. Median opioid consumption was similar (QLB-A: 11.25 MME, EA: 10 MME, p>0.05). Time to the first opioid request was slightly longer in QLB-A group (median 6.5 h vs 5 h, p>0.05).Conclusions QLB-A demonstrates promising comparable analgesic efficacy to EA for laparotomic hemicolectomies, supporting its use as a viable alternative.