QIPB vs SI-FICB for Postoperative Analgesia After Total Hip Arthroplasty

Comparison of Quadro-Iliac Plane Block and Supra-Inguinal Fascia Iliaca Compartment Block for Postoperative Analgesia in Total Hip Arthroplasty: A Prospective, Double-Blind, Non-Inferiority Study

Total hip arthroplasty (THA) causes moderate-to-severe postoperative pain. The PROSPECT guideline recommends the supra-inguinal fascia iliaca compartment block (SI-FICB) for THA, whereas evidence for newer quadratus-lumborum-family blocks is limited. The quadro-iliac plane block (QIPB) is a recently described fascial plane block, and no study has compared QIPB with SI-FICB head-to-head in any surgical context. In this prospective, double-blind, patients undergoing elective THA who receive one of the two routinely used preoperative blocks (SI-FICB or QIPB, chosen by the attending anesthesiologist as part of routine care) are systematically observed and compared. The primary objective is to assess whether the postoperative analgesic efficacy of QIPB is non-inferior to SI-FICB, using the resting NRS pain score at 6 hours postoperatively as the primary endpoint (non-inferiority margin Δ = 1.3).

Study Overview

• Status: Not yet recruiting
• Conditions: Postoperative Pain; Acute Pain; Hip Osteoarthritis; Total Hip Arthroplasty (THA)
• Intervention / Treatment: Procedure: Supra-Inguinal Fascia Iliaca Compartment Block; Procedure: Quadro-Iliac Plane Block

• Study Type: Interventional
• Enrollment (Estimated): 84
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Onur Küçük, associate professor; Phone Number: +90 5358543333; Email: onur.kucuk@deu.edu.tr

Study Locations

• Turkey (Türkiye)
  • Balçova
    • Izmir, Balçova, Turkey (Türkiye), 35340
      • Dokuz Eylül University
      • Contact: Onur Küçük, associate professor; Phone Number: +90 5358543333; Email: onur.kucuk@deu.edu.tr

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Adults aged 18-75 years
• Scheduled for elective primary total hip arthroplasty
• ASA physical status I-III
• Able to understand and communicate in Turkish and complete assessment scales
• Completed preoperative anesthesia evaluation and approved for surgery
• Signed written informed consent

Exclusion Criteria:

• Known allergy/contraindication to any local anesthetic, including bupivacaine
• Coagulopathy or anticoagulant/antiplatelet therapy contraindicating block (per ASRA 2022)
• Active infection or skin breakdown at the block site
• Chronic opioid use (≥3 months daily) or history of opioid dependence
• Morbid obesity (BMI > 40 kg/m²)
• Cognitive impairment or communication difficulty precluding reliable NRS/QoR-15 assessment
• Pregnancy or breastfeeding
• Revision THA or emergency THA for fracture
• Intraoperative complications requiring major protocol deviation (e.g., >1000 mL blood loss, cardiac arrest)
• Technically failed block (no sensory change at any region on the T1 cold test)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: SI-FICB; Patients receiving supra-inguinal fascia iliaca compartment block (single-shot, US-guided, 40 mL 0.25% bupivacaine, preoperative).	Procedure: Supra-Inguinal Fascia Iliaca Compartment Block; SIFICB is an ultrasound-guided fascial plane block performed via a supra-inguinal approach to the iliac fascia compartment, targeting the femoral nerve, lateral femoral cutaneous nerve, and obturator nerve. Single-shot, US-guided, 40 mL 0.25% bupivacaine, before GA induction.
Experimental: QIPB; Patients receiving quadro-iliac plane block (single-shot, US-guided, 40 mL 0.25% bupivacaine, preoperative).	Procedure: Quadro-Iliac Plane Block; QIPB is a facial plane block performed under ultrasound guidance with local anesthetic in the interfascial plane between the erector spinae and the quadratus lumborum muscle, at the distal attachment site of the quadratus lumborum muscle on the iliac crest. Single-shot, US-guided, 40 mL 0.25% bupivacaine, before GA induction.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity at rest at 6 hours postoperatively	Numeric Rating Scale (NRS), 0 = no pain to 10 = worst imaginable pain, measured at rest by a blinded assessor. Non-inferiority margin Δ = 1.3 NRS points.	6 hours after surgery

Secondary Outcome Measures

Outcome Measure	Time Frame
NRS pain at rest	0, 2, 4, 6, 12, 24, 48 hours postoperatively
NRS pain on movement (active hip flexion)	0, 2, 4, 6, 12, 24, 48 hours postoperatively
Cumulative opioid consumption	24 hours and 48 hours

Collaborators and Investigators

• Sponsor: Dokuz Eylul University
• Investigators: Principal Investigator: Onur Küçük, associate professor, Dokuz Eylül University

Study record dates

Study Major Dates

• Study Start (Estimated): June 30, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): June 1, 2027

Study Registration Dates

• First Submitted: June 23, 2026
• First Submitted That Met QC Criteria: June 27, 2026
• First Posted (Actual): July 6, 2026

Study Record Updates

• Last Update Posted (Actual): July 6, 2026
• Last Update Submitted That Met QC Criteria: June 27, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: quality of recovery; regional anesthesia; opioid consumption; fascia iliaca block; quadro-iliac plane block
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Musculoskeletal Diseases; Postoperative Complications; Pathologic Processes; Arthritis; Joint Diseases; Rheumatic Diseases; Osteoarthritis; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Acute Pain; Osteoarthritis, Hip
• Other Study ID Numbers: 2026/11-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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