Background: Clinical evidence revealed patients suffered from moderate to severe pain after renal transplantation. Both quadratus lumborum block (QLB) and erector spinae plane block (ESPB) are effective strategies in perioperative analgesia. This trial aims to detect whether truncal blocks are utility in alleviating postoperative pain after renal transplantation. Methods: Ninety-two patients underwent renal transplantation were recruited and randomized to QLB group, ESPB group and control group (C group). Patients in QLB or ESPB group received 0.5% ropivacaine 30 mL for single injection before surgery respectively and patients in C group did not receive any local anesthetic injection before general anesthesia induction. Postoperative pain intensity was evaluated at 0, 2, 4, 6, 8, 12, 24 and 48 h after surgery in the present study. Intraoperative medication and postoperative complications were also recorded and analyzed. Results: The proportion of moderate to severe pain in the first 24 h when moving was lowest in the QLB group (41.9% in QLB group vs. 83.9% in ESPB group vs. 96.7% in C group, P < 0.001). Pain intensity score (NRS) in the QLB group was significantly improved at 0, 2, 4, 6, 8 and 12 h after surgery (P < 0.05). Area under curve (AUCs) of NRS scores were significantly lower in the QLB group than in the ESPB group and C group (P < 0.001). We also observed a reduction of remifentanil consumption in the QLB group than in either the ESPB or C groups (P = 0.008 and P < 0.001, respectively). Conclusions: Quadratus lumborum block before surgery more effectively suppressed pain after renal transplantation relative to erector spinae plane block.