The opioid-sparing efficacy of ultrasound-guided quadro-iliac plane block versus transversus abdominis plane block after cesarean delivery: A randomized controlled trial.
5 affiliations
- 1Department of Anesthesia and Surgical ICU, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
- 2Department of Anesthesia, King Saud University Medical City, Riyadh, Saudi Arabia.
- 3College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- 4College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- 5Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
Abstract
Background
Post-cesarean pain comprises somatic and visceral components, yet the transversus abdominis plane (TAP) block addresses only somatic afferents. The quadro-iliac plane block (QIPB) is a novel posterior fascial plane technique theorized to provide broader coverage of both nociceptive pathways. Comparative evidence between these techniques in the obstetric population is lacking.Methods
This prospective, randomized, single-blind, controlled trial enrolled 36 ASA I-II parturients undergoing elective cesarean delivery under spinal anesthesia at Mansoura University Hospital (IRB: R.25.04.3145; PACTR202505592518309). Patients were randomized 1:1 to bilateral ultrasound-guided TAP block (n = 18) or bilateral QIPB (n = 18). The primary outcome was total nalbuphine consumption within 24 hours. Secondary outcomes included time to first rescue analgesic request, postoperative Visual Analogue Scale (VAS) pain scores, hemodynamic parameters, and adverse effects.Results
Twenty-four-hour nalbuphine consumption was significantly lower in the QIPB group (5.28 ± 0.96 mg vs. 9.56 ± 2.04 mg; P < 0.001), representing a 45% reduction. The time to first rescue analgesia was significantly prolonged with QIPB (9.78 ± 1.22 vs. 7.0 ± 1.32 hours; P < 0.001). VAS scores were significantly lower at 6 and 12 hours postoperatively (P < 0.001 and P = 0.007, respectively). No clinically relevant hemodynamic differences were observed between groups, and adverse event rates were comparable.Conclusions
Compared with the TAP block, the QIPB provides superior and more prolonged postoperative analgesia following elective cesarean delivery, with a favorable safety profile. These findings support further evaluation of the QIPB within multimodal Enhanced Recovery After Cesarean protocols, particularly where intrathecal opioid is not employed, and inform the design of future multicenter trials.
Related
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- Comparison of External Oblique Intercostal Plane Block and Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia After Open Radical Gastrectomy: A Single-Blind Randomized Trial
- Quadratus Lumborum versus Transversus Abdominis Plane Block with Oxycodone or Sufentanil for Recovery Quality After Laparoscopic Gastrointestinal Cancer Surgery: A Factorial Randomized Trial.
- Anatomical spread of the novel transversus abdominis–rectus abdominis aponeurotic (TARAA) block: a cadaveric comparison with lateral transversus abdominis plane (TAP) and combined TAP-rectus sheath blocks
BibTeX
@article{salama2026opioidsparing,
title = {{The opioid-sparing efficacy of ultrasound-guided quadro-iliac plane block versus transversus abdominis plane block after cesarean delivery: A randomized controlled trial.}},
author = {Mohamed A Salama and Fatma K Al Dammas and Abdullah AlDhuwaihy and Marwan A Almalki and Turki M Alhakbani and Yazan F AlAhmari and Rakan Alarifi and Jawad Alhabeeb and Mostafa Nagy and Ahmed A Shaaban and Amani Taraby},
journal = {Saudi journal of anaesthesia},
year = {2026},
month = oct,
doi = {10.4103/sja.sja_477_26},
url = {https://europepmc.org/article/MED/42960056},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - The opioid-sparing efficacy of ultrasound-guided quadro-iliac plane block versus transversus abdominis plane block after cesarean delivery: A randomized controlled trial.
AU - Mohamed A Salama
AU - Fatma K Al Dammas
AU - Abdullah AlDhuwaihy
AU - Marwan A Almalki
AU - Turki M Alhakbani
AU - Yazan F AlAhmari
AU - Rakan Alarifi
AU - Jawad Alhabeeb
AU - Mostafa Nagy
AU - Ahmed A Shaaban
AU - Amani Taraby
PY - 2026
DA - 2026/10/01
JO - Saudi journal of anaesthesia
DO - 10.4103/sja.sja_477_26
UR - https://europepmc.org/article/MED/42960056
AB - Background Post-cesarean pain comprises somatic and visceral components, yet the transversus abdominis plane (TAP) block addresses only somatic afferents. The quadro-iliac plane block (QIPB) is a novel posterior fascial plane technique theorized to provide broader coverage of both nociceptive pathways. Comparative evidence between these techniques in the obstetric population is lacking.Methods This prospective, randomized, single-blind, controlled trial enrolled 36 ASA I-II parturients undergoing elective cesarean delivery under spinal anesthesia at Mansoura University Hospital (IRB: R.25.04.3145; PACTR202505592518309). Patients were randomized 1:1 to bilateral ultrasound-guided TAP block (n = 18) or bilateral QIPB (n = 18). The primary outcome was total nalbuphine consumption within 24 hours. Secondary outcomes included time to first rescue analgesic request, postoperative Visual Analogue Scale (VAS) pain scores, hemodynamic parameters, and adverse effects.Results Twenty-four-hour nalbuphine consumption was significantly lower in the QIPB group (5.28 ± 0.96 mg vs. 9.56 ± 2.04 mg; P < 0.001), representing a 45% reduction. The time to first rescue analgesia was significantly prolonged with QIPB (9.78 ± 1.22 vs. 7.0 ± 1.32 hours; P < 0.001). VAS scores were significantly lower at 6 and 12 hours postoperatively (P < 0.001 and P = 0.007, respectively). No clinically relevant hemodynamic differences were observed between groups, and adverse event rates were comparable.Conclusions Compared with the TAP block, the QIPB provides superior and more prolonged postoperative analgesia following elective cesarean delivery, with a favorable safety profile. These findings support further evaluation of the QIPB within multimodal Enhanced Recovery After Cesarean protocols, particularly where intrathecal opioid is not employed, and inform the design of future multicenter trials.
SN - 1658-354X
SN - 0975-3125
ER -