A novel fascial plane block for pediatric open pyeloplasty: Clinical experience with the quadro-iliac plane block—A report of five cases

ABSTRACT Open pyeloplasty in children is often associated with significant postoperative pain, and providing effective analgesia while limiting opioid exposure remains challenging. We describe our experience with the ultrasound-guided Quadro-Iliac Plane Block (QIPB), a recently described fascial plane block, in five children aged 2–7 years undergoing open pyeloplasty. Following induction of general anesthesia, a unilateral QIPB was performed using 0.2% ropivacaine (0.5 mL/kg). Postoperative pain was assessed using the FLACC scale over 24 hours, and the need for rescue analgesia was documented. All children had low pain scores in the early postoperative period, with median FLACC scores remaining ≤3. Three patients required a single dose of rescue fentanyl between 13 and 16 hours postoperatively, likely corresponding to block wear-off. No adverse effects, motor weakness, nausea, or vomiting were observed. Our experience suggests that QIPB may offer effective, opioid-sparing, and motor-preserving analgesia for pediatric open pyeloplasty, although larger controlled studies are needed.