Objective To investigate the effect of ultrasound⁃guided anterior quadratuslumborum block at lateral supra arcuate ligament on postoperative pain and early recovery in elderly patients undergoing laparoscopic radical nephrectomy. Methods Eighty patients aged 65 to 75，ASA grade Ⅰ to Ⅲ，scheduled for laparoscopic radical nephrectomy were randomly divided into two groups（n = 40）：an anterior quadratuslumborum block at lateral supra⁃arcuate ligament group（group Q）and a control group（group C）. The rate of remedial analgesia，the Visual analogue scale（VAS）score，the effective pressing times of patient⁃controlled analgesia（PCA）in 48 hours after surgery，and uses of intraoperative anesthetic dosage and the early recovery indexes were recorded in both groups. Results The rate of remedial analgesia in 48 hours after surgery and the VAS score at postoperative hours 1，12，24 and 48 were significantly lower in group Q than in group C（P < 0.05）. The effective pressing times of PCA were significantly fewer in group Q than in group C（P < 0.05）. The cumulative uses of remifentanil and the incidence of nausea and vomiting were significantly lower in group Q than in group C（P < 0.05）. The awakening time，initial time to getting out of bed，and postoperative hospital stay were significantly shorter in group Q than in group C（P < 0.05）. Conclusions Ultrasound guided anterior quadratuslumborum block at lateral supra arcuate ligament can markedly relieve perioperative pain，reduce uses of perioperative analgesic dosage and the incidence of nausea and vomiting，and accelerate the early recovery in elderly patients undergoing laparoscopic radical nephrectomy.