The quadro-iliac plane block: a systematic review of a promising novel technique

The Quadroiliac Plane Block (QIPB) is an emerging fascial plane block designed to provide extensive analgesia for various surgical procedures. While its use has been described in preliminary reports, a comprehensive evaluation of the existing evidence is needed. This systematic review aimed to evaluate the clinical applications, efficacy, and safety of the QIPB by analyzing all available published literature. A comprehensive search of PubMed, Scopus, Embase, and Web of Science was conducted up to September 4, 2025. Inclusion criteria encompassed all study designs, including randomized controlled trials (RCTs), case series, and case reports. Data on surgical context, pain scores, rescue analgesia, and adverse events were extracted. The quality of RCTs was assessed using the Cochrane Risk of Bias 2 tool, while the JBI Critical Appraisal Checklist was used for observational studies. Nineteen studies, including two RCTs and 17 observational studies comprising a total of 164 patients, met the inclusion criteria. The RCTs provided the primary efficacy data: one demonstrated that the QIPB was non-inferior to the Erector Spinae Plane (ESP) block for lumbar discectomy, while the other suggested superiority over standard analgesia for hip arthroplasty. Observational studies described the block’s use in a wide range of orthopedic, spinal, and abdominal surgeries, with reported outcomes appearing to be context-dependent. The QIPB is an emerging regional anesthesia technique with preliminary evidence suggesting non-inferiority to the ESP block in some contexts. However, the current evidence is limited by the variable quality of the included studies and inconsistent safety reporting. The definitive role of the QIPB will be clarified by several ongoing RCTs that are expected to provide higher-quality evidence on its comparative effectiveness and safety. 1. The current evidence for the QIPB consists of two small RCTs of variable methodological quality and a larger body of preliminary case reports and series. 2. The strongest available evidence suggests the QIPB is non-inferior to the ESP block for lumbar discectomy, while observational data report variable analgesic outcomes that appear dependent on the specific surgical context. 3. Significant limitations in the current literature, including a high risk of bias in one RCT and inconsistent reporting of adverse events in the case studies, prevent definitive conclusions about the block’s overall efficacy and safety profile. 4. The definitive role of the QIPB will be clarified by several ongoing RCTs that are expected to provide high-quality evidence on its comparative effectiveness and safety in various clinical settings.