Evaluation of the postoperative analgesic efficacy of the quadroiliac plane block in partial hip replacement surgery: a prospective randomized controlled bicentric study

BACKGROUND: Effective postoperative pain management is essential for optimizing recovery after partial hip replacement surgery, particularly in elderly patients with multiple comorbidities. The quadroiliac plane block (QIPB) is a recently described ultrasound-guided fascial plane block that targets the fascial plane beneath the quadratus lumborum muscle at the inner iliac crest, with potential to provide extensive periarticular coverage. METHODS: Thirty adult patients were randomized to receive either a unilateral QIPB (40 mL 0.25% bupivacaine) or no block following surgery under spinal anesthesia. All patients received standardized multimodal analgesia including IV fentanyl PCA and paracetamol. The primary outcome was total fentanyl consumption in the first 24 hours. Secondary outcomes included pain scores at 1, 6, 12, and 24 hours; rescue analgesia requirements; postoperative nausea and vomiting (PONV); dermatomal spread; and Quality of Recovery-15 (QoR-15) scores. RESULTS: Median fentanyl consumption was significantly lower in the block group (100 µg [IQR 80-120]) compared to control (300 µg [IQR 270-360]; P<0.001). NRS pain scores were significantly lower at 1, 6, and 12 hours (P<0.01), but not at 24 hours. QoR-15 scores were higher and PONV and rescue analgesia rates were lower in the block group. Dermatomal mapping showed consistent L1-L5 coverage, with cranial extension to T10-T12 and caudal spread to S1-S2 in most patients. No block-related complications were observed. CONCLUSIONS: QIPB provides reliable and opioid-sparing analgesia with extensive sensory coverage, representing a safe and effective regional technique to optimize recovery after partial hip replacement surgery.