Effect of Ultrasound-Guided Quadro-Iliac Plane Block on Postoperative Analgesia After Lumbar Spinal Surgery

Evaluation of the Effect of Ultrasound-Guided Quadro-Iliac Plane Block on Postoperative Analgesia in Patients Undergoing Lumbar Spinal Surgery

This prospective observational study aims to evaluate the effect of ultrasound-guided Quadro-Iliac Plane Block (QIPB) on postoperative analgesia in patients undergoing lumbar spinal surgery. Lumbar spinal procedures are commonly associated with significant postoperative pain, which may impair early mobilization and increase opioid consumption. In routine clinical practice, QIPB is increasingly used as part of multimodal analgesia to improve pain control and reduce opioid-related adverse effects.

Adult patients scheduled for elective lumbar spinal surgery under general anesthesia will be followed according to routine clinical care. Postoperative analgesia will be managed with intravenous patient-controlled analgesia (PCA) using tramadol, with or without the addition of ultrasound-guided QIPB, based on the preference of the attending anesthesiologist. No intervention or treatment assignment will be performed by the investigators.

Postoperative pain scores at rest and during movement, opioid consumption, need for rescue analgesics, incidence of nausea and vomiting, and patient satisfaction will be recorded during the first 24 hours after surgery. The findings of this study are expected to provide further clinical evidence regarding the effectiveness of QIPB as part of multimodal analgesia in lumbar spinal surgery.

Study Overview

• Status: Recruiting
• Conditions: Postoperative Pain; Postoperative Analgesia; Lumbar Spine Surgery
• Intervention / Treatment: Other: QIPB; Other: LAI

Detailed Description

This is a single-center, prospective observational cohort study conducted in patients undergoing elective lumbar spinal surgery under general anesthesia. The study is designed to assess the effects of ultrasound-guided Quadro-Iliac Plane Block (QIPB) on postoperative analgesia when used as part of routine multimodal pain management.

Eligible patients aged 18-65 years with American Society of Anesthesiologists (ASA) physical status I-III and a body mass index below 35 kg/m² will be included after providing written informed consent. All patients will receive standardized general anesthesia and postoperative intravenous patient-controlled analgesia (PCA) with tramadol as part of routine care. The decision to perform QIPB will be made by the attending anesthesiologist according to clinical judgment and routine practice, without any intervention or assignment by the research team.

Ultrasound-guided QIPB, when applied, will be performed bilaterally under sterile conditions in the prone position at the end of surgery. In patients who do not receive QIPB, the surgeon will perform local anesthetic infiltration (LAI) of the incision site as part of routine postoperative analgesia. Patients will be observed in two cohorts: those receiving PCA with LAI and those receiving PCA with QIPB.

Postoperative outcomes will be assessed in the post-anesthesia care unit and at 1, 6, 12, and 24 hours postoperatively. Pain intensity will be evaluated using the Numeric Rating Scale (NRS) at rest and during movement. Secondary outcomes will include total opioid consumption, time to first rescue analgesic requirement, incidence of postoperative nausea and vomiting, sedation level, and patient satisfaction assessed using a 5-point Likert scale at 24 hours. Any block-related complications will also be recorded.

Data will be analyzed using appropriate statistical methods to compare postoperative analgesic outcomes between the two cohorts. This observational study aims to reflect real-world clinical practice and contribute to the growing evidence on the role of QIPB in postoperative pain management after lumbar spinal surgery.

• Study Type: Observational
• Enrollment (Estimated): 60

Contacts and Locations

• Study Contact: Name: Elif Acar Deger, Dr.; Phone Number: +905069435510; Email: drelifacardeger@gmail.com

Study Locations

• Turkey (Türkiye)
  • Istanbul
    • Istanbul, Istanbul, Turkey (Türkiye), 34752
      • Recruiting
      • Fatih Sultan Mehmet Training and Research Hospital
      • Contact: Elif Acar Deger, MD; Phone Number: +90 506 943 55 10; Email: drelifacardeger@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adult patients aged 18-65 years with ASA physical status I-III and body mass index <35 kg/m² scheduled for elective posterior lumbar segmental instrumentation surgery under general anesthesia. All participants provide written informed consent prior to enrollment.

Description

Inclusion Criteria:

• Patients aged between 18 and 65 years
• American Society of Anesthesiologists (ASA) physical status I-III
• Body mass index (BMI) <35 kg/m²
• Scheduled for elective posterior lumbar spinal instrumentation surgery under general anesthesia

Exclusion Criteria:

• Refusal to participate in the study
• Emergency surgery
• Local infection or hematoma at the block application site
• Previous surgery at the block application site
• Presence of coagulopathy
• Known allergy or toxicity to local anesthetics
• History of hematological, renal, or hepatic disease, or advanced respiratory or cardiac failure
• Chronic analgesic use, chronic alcohol consumption, or substance abuse
• Inability to speak Turkish or presence of language/communication barriers

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
PCA + QIPB Group; Patients who receive standard postoperative intravenous patient-controlled analgesia (PCA) with tramadol in combination with ultrasound-guided Quadro-Iliac Plane Block (QIPB) as part of routine clinical care following lumbar spinal surgery.	Other: QIPB; Quadro-Iliac Plane Block using local anesthetic.
PCA + LAI Group; Patients who receive standard postoperative intravenous patient-controlled analgesia (PCA) with tramadol alone without the addition of any regional analgesic block following lumbar spinal surgery. In addition, the surgeon will perform local anesthetic infiltration (LAI) of the incision site as part of the routine analgesia protocol.	Other: LAI; The surgeon will perform local anesthetic infiltration (LAI) of the incision site.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative Pain Intensity	Postoperative pain intensity assessed using the Numeric Rating Scale (NRS), where 0 indicates no pain and 10 indicates the worst imaginable pain.	Within the first 24 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Opioid Consumption	Total amount of tramadol consumption administered via intravenous patient-controlled analgesia during the first 24 hours postoperatively.	Within the first 24 hours after surgery
Requirement for Rescue Analgesia	Need for additional rescue analgesic medication during the first 24 hours postoperatively.	Within the first 24 hours after surgery
Postoperative Nausea and Vomiting	Incidence of postoperative nausea and vomiting during the first 24 hours after surgery.	Within the first 24 hours after surgery
Patient Satisfaction With Pain Management	Patient satisfaction with postoperative pain management was assessed at 24 hours after surgery using a 5-point Likert Satisfaction Scale (range: 1-5), where 1 = "not satisfied at all," 2 = "not satisfied," 3 = "neutral," 4 = "satisfied," and 5 = "very satisfied," with higher scores indicating greater patient satisfaction.	24 hours after surgery

Collaborators and Investigators

• Sponsor: Fatih Sultan Mehmet Training and Research Hospital
• Investigators: Principal Investigator: Oznur Demiroluk, Assoc. Prof., Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye

Study record dates

Study Major Dates

• Study Start (Actual): January 5, 2026
• Primary Completion (Estimated): October 1, 2026
• Study Completion (Estimated): October 1, 2026

Study Registration Dates

• First Submitted: December 26, 2025
• First Submitted That Met QC Criteria: December 26, 2025
• First Posted (Actual): January 8, 2026

Study Record Updates

• Last Update Posted (Actual): February 23, 2026
• Last Update Submitted That Met QC Criteria: February 19, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Postoperative Analgesia; Patient-Controlled Analgesia; Lumbar Spinal Surgery; Ultrasound-Guided Regional Anesthesia; Quadro-Iliac Plane Block; QIPB
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative
• Other Study ID Numbers: 2025/397

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared, as data sharing was not planned at the time of study design and is not included in the ethical approval.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No