Comparison of quadro-iliac plane block and erector spinae plane block for postoperative analgesia management after single level lumbar discectomy surgery: a randomized, double-blind, controlled, prospective, multicenter study.

PURPOSE

Effective postoperative analgesia management is critical for optimizing recovery and patient satisfaction following lumbar discectomy. Erector Spinae Plane Block (ESPB) is an established regional anesthesia technique with proven efficacy, while the novel Quadro-Iliac Plane Block (QIPB) has shown promise as an alternative approach. This study compares the analgesic efficacy, opioid-sparing potential, and safety of ESPB and QIPB in single-level lumbar discectomies.

METHOD

This multicenter, prospective, randomized, double-blind study included 60 patients aged 18-65 years undergoing single-level lumbar discectomy. Patients were randomized into ESPB (n = 30) and QIPB (n = 30) groups. Both blocks were performed at the end of surgery, before the extubation under ultrasound guidance using 40 ml (0.25%) bupivacaine bilaterally. The primary outcome was postoperative pain assessed by the Numeric Rating Scale (NRS) at 12 h. Secondary outcomes included tramadol consumption, rescue analgesia requirements, hemodynamic parameters, and adverse events.

RESULTS

The primary outcome, 12-h NRS scores, did not differ significantly between groups (p > 0.05), indicating similar analgesic efficacy. Secondary outcomes-including total tramadol consumption (54.00 ± 49.03 mg for ESPB vs. 44.67 ± 44.16 mg for QIPB, p = 0.476), need for rescue analgesia, and incidence of nausea and vomiting-were also comparable. No motor block was observed in either group.

CONCLUSION

Although QIPB did not demonstrate superiority over ESPB, it was found to be not inferior in analgesic effect and safety outcomes. These findings suggest that QIPB may be a reliable alternative to ESPB in lumbar discectomy procedures.