Recovery after Hip Arthroplasty with Quadro-Iliac Plane Block: A Randomised Trial

By Muhammed Halit Satici¹, Mahmut Sami Tutar¹, Betul Kozanhan¹, Munise Yildiz¹, Ahmet Yildirim², Nuray Altay³

Affiliations

1. Department of Anaesthesiology and Reanimation, University of Health Sciences, Konya City Hospital, Konya, Turkiye
2. Department of Orthopaedics and Traumatology, University of Health Sciences, Konya City Hospital, Konya, Turkiye
3. Department of Anaesthesiology and Reanimation, Faculty of Medicine, Harran University, Sanliurfa, Turkiye

doi: 10.29271/jcpsp.2025.08.947

ABSTRACT
Objective: To evaluate the effectiveness of the quadro-iliac plane block (QIPB) in enhancing postoperative recovery after total hip arthroplasty (THA), using the quality of recovery-15 (QoR-15) score.
Study Design: Randomised, controlled, multicentre study.
Place and Duration of the Study: Konya City Hospital and Harran University, Faculty of Medicine, Turkiye, between March and April 2025.
Methodology: Patients were randomised to receive either the QIPB (Group Q) or multimodal analgesia alone (Group C), with a total of 64 participants enrolled. The primary measure was the QoR-15 score, evaluated 24 hours postoperatively. The total QoR-15 scores were normally distributed and compared between the groups using an independent samples t-test. Secondary measures comprised postoperative pain intensity, the quantity of rescue analgesics administered, time to initial analgesic intervention, overall patient satisfaction, and the incidence of nausea, vomiting, and antiemetic administration.
Results: Group Q demonstrated significantly higher QoR-15 scores compared to Group C (Group Q: 127 ± 4; Group C: 89 ± 7; p <0.001). Furthermore, Group Q achieved superior scores across all subdomains, including postoperative pain, physical comfort, physical independence, psychological support, and emotional state (p <0.001).
Conclusion: The QIPB is a novel and effective regional analgesic technique that offers significant postoperative pain relief, enhances patient comfort and satisfaction, and contributes positively to the quality of recovery after THA.

Key Words: Postoperative pain management, Regional anaesthesia, Quadro-iliac plane block, Quality of recovery-15, Total hip arthroplasty.

INTRODUCTION

Total hip arthroplasty (THA) is frequently utilised in elderly patients to address hip pain and restore joint function.¹ Effective postoperative pain management is critical; however, the use of opioids is associated with a range of adverse effects, including nausea, vomiting, pruritus, constipation, respiratory depression, and the risk of dependence. These limitations necessitate the need for alternative, opioid-sparing analgesic strategies.² Regional analgesia is frequently employed as a part of multimodal strategies to manage postoperative pain and reduce opioid consumption following hip surgery. Techniques such as lumbar plexus block (LPB), fascia iliaca block, parasacral block, femoral nerve block, obturator nerve block, and epidural analgesia have all been utilised for this purpose.^3-5

The quadratus lumborum block (QLB) has emerged as a promising alternative; however, its reliability in targeting the nerves supplying the hip and lower limb remains inconsistent.^6,7 More recently, the quadro-iliac plane block (QIPB) has been introduced, combining elements of both posterior and anterior QLB approaches.⁶ Anatomical studies demonstrate that QIPB facilitates extensive dye spread along the anterior and posterior aspects of the quadratus lumborum muscle, reaching the interfascial planes near the erector spinae and latissimus dorsi muscles.⁶ It also stains key neural structures, including components of lumbar plexus, ilioinguinal and iliohypogastric nerves, and posterior branches innervating the lumbosacral paraspinal region.⁶ These findings suggest that QIPB may provide a broader sensory blockade, potentially enhancing analgesia following THA. Moreover, recent clinical data have supported its utility in hip-related surgeries. A study demonstrated the efficacy of the QIPB in managing postoperative pain in patients undergoing proximal femoral nail surgeries.⁸

Despite the growing interest in fascial plane blocks, the clinical efficacy of the QIPB in the context of THA has not yet been evaluated in any randomised controlled trial (RCT). The absence of clinical evidence regarding its analgesic and recovery- enhancing effects has been identified as a relevant literature gap. Therefore, this study was undertaken to investigate whether the addition of QIPB to standard multimodal analgesia could improve postoperative outcomes in patients undergoing THA.

This study aimed to evaluate the impact of QIPB on postoperative recovery in patients undergoing THA, with the quality of recovery-15 (QoR-15) score as the primary outcome measure. Secondary objectives included the assessment of postoperative pain intensity, timing and requirement for rescue analgesia, patient satisfaction, incidence of nausea, vomiting, and the need for antiemetic medication.

METHODOLOGY

Ethical approval for this multicentre study was granted by the Clinical Research Ethics Committee of Harran University, Faculty of Medicine, Sanliurfa, Turkiye (Approval No. 25.02.15; Dated: 27 January 2025). In addition, institutional permission was obtained from the Konya City Hospital (Decision No. 01-65; Dated: 2 January 2025).

The trial was prospectively registered at ClinicalTrials.gov (Identifier: NCT06870071). All procedures were conducted in line with the ethical standards set out in the 2013 update of the Declaration of Helsinki. The study was reported in accordance with the CONSORT guidelines.⁹ Prior to randomisation, both written and verbal informed consent were obtained from all the participants.

The study was conducted at the Konya City Hospital and Harran University Medical Faculty, Turkiye, between March and April 2025. It included patients aged 18–85 years undergoing unilateral THA under spinal anaesthesia, with an American Society of Anesthesiologists (ASA) physical status of I–IV, and expected to remain hospitalised for at least 24 hours postoperatively. Exclusion criteria included lack of consent, contraindications to regional anaesthesia, impaired consciousness, anticoagulant therapy, infection at the block site, emergency surgery, and any communication difficulties or observed inability to comprehend postoperative assessments.

Randomisation was centrally performed using a computer- generated sequence via a secure web-based system, with allocation concealed until enrolment. At each centre, an anaesthetist — uninvolved in follow-up, data collection, or analysis — accessed the system to assign patients to either Group Q (QIPB plus intravenous paracetamol and dexketoprofen) or Group C (intravenous paracetamol and dexketoprofen only). Distinct roles were assigned to separate specialists to preserve blinding and methodological rigour. QIPB procedures were performed by anaesthetists, with at least five years of experience and no involvement in patient allocation, follow-up, or outcome assessment. Postoperative evaluations were conducted by two independent, blinded anaesthetists, who recorded primary and secondary outcomes, including pain scores and rescue analgesic use. This study followed a single-blind design, in which the postoperative outcome assessors were blinded to the group assignments.

All patients underwent standard monitoring and anaesthesia management. A 20-gauge intravenous (IV) cannula was inserted, and isotonic fluids were administered at 15 mL/kg/h. A lumbar puncture at L3–L4 or L4–L5 was performed to administer 3 mL of 0.5% bupivacaine for spinal anaesthesia. Postoperatively, all patients received intravenous paracetamol (1g, three times daily) and dexketoprofen (50 mg, twice daily) for analgesia.

After surgery, patients in Group Q received QIPB in the post- anaesthesia care unit (PACU). IV tramadol at a dose of 1 mg/kg was administered as rescue analgesia when the numerical rating scale (NRS) score was ≥3. IV ondansetron (4 mg) was given to patients experiencing nausea or vomiting.

After surgery, patients in Group Q underwent a unilateral QIPB targeting the surgical side in the PACU. Under aseptic conditions, patients were positioned laterally. A low-frequency convex ultrasound probe (2–6 MHz) and a 100 mm, 22G short- bevel needle (Stimuplex A, B. Braun, Germany) were used. After sterilisation of the lumbar region and the probe, the transducer was placed parasagittally at the distal attachment of the QLM to the iliac crest. The iliac crest and QLM were identified, with the erector spinae muscle (ESM) located superiorly and the psoas major muscle inferiorly. Using an in-plane technique, the needle was advanced towards the iliac crest. Correct plane identification was confirmed by injecting 5 mL of isotonic saline between the ESM and QLM. After negative aspiration to avoid intravascular injection, 40 mL of 0.25% bupivacaine was administered with intermittent aspiration.

The primary outcome was the QoR-15 score, assessed 24 hours postoperatively. This tool consists of 15 questions, each scored on a 10-point scale, yielding a maximum of 150. It encompasses five domains; physical comfort (questions 1–4, 13), emotional state (questions 9, 10, 14, 15), psychological support (questions 6, 7), physical independence (questions 5, 8), and pain (questions 11, 12).¹⁰

Secondary outcomes comprised pain scores assessed via the NRS at rest and on movement at multiple postoperative points (0, 2, 4, 6, 8, 12, and 24 hours). Additional measures included cumulative rescue analgesic use, time to first analgesic request, incidence of nausea and vomiting, and the need for antiemetics. Patient satisfaction was evaluated at 24 hours using a five-point Likert scale.

Sample size calculation was based on the assumption that a 6-point difference in the QoR-15 scores represents the minimal clinically important difference.¹¹ A previous study in patients undergoing THA reported a mean QoR-15 score of 100.69 ± 7.65 in the control group.¹² Based on these data, the required sample size was calculated for an independent t-test, with a Cohen’s d effect size of 0.784. To achieve 90% power with a 5% Type I error rate, a minimum of 29 patients per group was required. Taking potential attrition into consideration, the sample size was adjusted to 32 patients per group (n = 64 in total).

Table I: Characteristics of participants at baseline.

Factors	Group C (n = 32)	Group Q (n = 32)	p-values
Age (year)	59 ± 11	64 ± 11	0.066
Female	19 (59.4%)	16 (50%)	0.451
ASA physical status			0.077
1	4 (12.5%)	2 (6.3%)
2	23 (71.9%)	17 (53.1%)
3	5 (15.6%)	13 (40.6%)
Smoking	4 (12.5%)	3 (9.4%)	0.689
Coronary artery disease	5 (15.6%)	4 (12.5%)	0.719
Hypertension	9 (28.1%)	14 (43.8%)	0.193
Lung disease	3 (9.4%)	3 (9.4%)	1
Diabetes	7 (21.9%)	5 (15.6%)	0.522
Height (cm)	166 ± 6	167 ± 7	0.858
Weight (kg)	67 ± 6	69 ± 9	0.375
BMI (kgm-2)	24.4 ± 1.4	24.9 ± 2.3	0.280
Surgery time (minutes)	115 (120-135)	120 (120-130)	0.336
Data presented as mean ± standard deviation, median (Q1-Q3), or n (%). ASA: American Society of Anesthesiologists; cm: Centimetre; Kg: Kilogram; BMI: Body mass index; Min: Minutes. The p-values were calculated using the independent samples t-test for normally distributed continuous variables, the Mann–Whitney U test for non-normally distributed continuous variables, and the Chi-square test for categorical variables, as appropriate.

Table II: Comparative analysis of overall and subdomain QoR-15 scores between the studied groups.

Quality of recovery-15	Group C (n = 32)	Group Q (n = 32)	p-values
Pain	13 (11-14)	19 (19-19)	<0.001
Physical comfort	30 (29-33)	46 (44-47)	<0.001
Physical independence	9 (6-11)	12 (11-14)	<0.001
Psychological support	12 (11-13)	15 (15-16)	<0.001
Emotional state	26 (24-28)	35 (34.50-35)	<0.001
Total QoR-15 scores	89 ± 7	127 ± 4	<0.001
Data presented as mean ± standard deviation, median (Q1-Q3). The p-values were calculated using the independent samples t-test for normally distributed continuous variables and the Mann–Whitney U test for non-normally distributed continuous variables.

Table III: Postoperative rescue analgesia characteristics between the groups.

Factors	Group C (n = 32)	Group Q (n = 32)	p-values
First rescue analgesia time (hours)	4 (2-4)	24 (24-24)	<0.001
Tramadol consumption (mg)	210 (195-243)	0 (0-0)	<0.001
Rescue analgesia usage, time frame (hours)
0-6	32 (100%)	0 (0%)	<0.001
6-12	31 (96.9%)	0 (0%)	<0.001
12-24	13 (40.6%)	5 (15.6%)	0.026
0-24	32 (100%)	5 (15.6%)	<0.001
Data presented as median (Q1-Q3) or n (%). h: Hour; mg: Milligram. The p-values were calculated using the Mann–Whitney U test for non-normally distributed continuous variables and the chi-square test for categorical variables.

Statistical analysis was performed using IBM SPSS Statistics (version 26.0; IBM-SPSS Inc., Chicago, IL, USA). Normality of continuous data was assessed with the Shapiro–Wilk test. Results were reported as mean ± standard deviation or median (interquartile range), depending on distribution. Categorical variables were presented as counts and percen-tages. Group comparisons used either the independent t-test or the Mann–Whitney U test. The Chi-square or Fisher’s exact test was applied for categorical data. Changes over time were evaluated with repeated measures ANOVA. Statistical significance was set at p <0.05.

RESULTS

The initial screening identified sixty-nine individuals as potential participants. Of these, three did not meet the inclusion criteria, and two declined to participate. The remaining sixty-four were randomly assigned to Group C and Group Q, with 32 patients in each group (Figure I).
 

No significant differences were observed between the groups in terms of demographic features or surgical duration (Table I).

Two randomised groups undergoing THA were compared with respect to postoperative recovery, assessed by the QoR-15 score. Group Q demonstrated significantly higher QoR-15 scores compared to Group C (127 ± 4 vs. 89 ± 7; p <0.001). Group Q also showed significantly higher scores across all subscales, including postoperative pain, physical comfort, physical independence, psychological support, and emotional state (p <0.001 for each, Table II).

During the first 24 hours postoperatively, both resting and movement-associated NRS scores were consistently higher in Group C across all time points, with statistically signifi-cant differences observed at each assessment (Figure 2A-B). Furthermore, analysis of changes in NRS scores over time revealed a significant time group interaction for both rest and movement (p <0.001 for each, Figure 2A-B).

Figure 1: A consort flow diagram illustrating the progression of partici-pants throughout the study.
QIPB: Quadro-iliac plane block; LA: Local anaesthetic

Figure 2(A): Postoperatvie NRS scores at rest with 95% CI.
CI: Confidence interval; NRS: Numerical rating scale

Figure 2(B): Postoperatvie NRS scores at movement with 95% CI.
CI: Confidence interval; NRS: Numerical rating scale

Postoperative rescue analgesia requirements are summarised in Table III. Over the 24-hour postoperative period, Group C required significantly more analgesic intervention than Group Q. The number of patients receiving rescue analgesia, cumu-lative tramadol consumption, and time to first analgesic request were all significantly in favour of Group Q across all assessed time intervals.

Within the first 24 postoperative hours, postoperative nausea and vomiting (PONV) were observed in 14 (43.8%) patients of Group C and 4 (12.5%) patients of Group Q (p = 0.005). The need for antiemetic medication was significantly lower in Group Q compared to Group C (4 vs. 14 patients, p = 0.005). Patient satisfaction scores on the Likert scale were significantly higher in Group Q than in Group C [5 (4-5) vs. 3 (2-3); p <0.001].

DISCUSSION

This multicentre, prospective, RCT demonstrated that the utilisation of QIPB in patients undergoing THA significantly enhanced postoperative recovery quality, as reflected by higher QoR-15 scores, provided superior analgesia, prolonged time to initial rescue analgesia, and reduced the overall requirement for additional analgesics. Notably, this is the first comprehensive study evaluating the efficacy of QIPB in THA surgery.

A cadaveric study by Tulgar et al. demonstrated that in QIPB, local anaesthetic is injected near the posterior fascia of the QLM at the level of the iliac crest, resulting in extensive spread through the deep interfascial planes and along the transversalis fascia​​.⁶ This spread stained the ilioinguinal, iliohypogastric, and genitofemoral nerves, as well as components of the lumbar plexus bilaterally, suggesting that a single injection could achieve multilevel blockade from T12 to L4. These findings support the potential of QIPB to provide widespread analgesia across the lower abdominal, lumbo-sacral, and hip regions.⁶ QIPB has been effectively used in chronic pain, inguinal hernia, lumbar, and renal surgeries.^13-16

In this study, QoR-15 scores at 24 hours were significantly greater in the QIPB group than in the control group. Improvements were not limited to the total QoR-15 score; however, significant enhancements were also observed across all subdomains, including pain, physical comfort, physical independence, emotional state, and psychological support. These results indicate that QIPB contributes not only to effective analgesia but also to the overall physical and emotional well-being of patients, leading to a more satisfactory recovery process. Likewise, previous studies investigating other regional anaesthesia techniques — such as the sacral erector spinae plane block (S-ESPB), peri-capsular nerve group (PENG) block, and fascia iliaca block — have reported improvements in QoR-15 scores following hip surgery.^4,17-19

The magnitude of improvement observed in this study exceeded the minimal clinically important difference for the QoR-15 score, defined as a 6-point change, underscoring the clinical relevance of QIPB in enhancing postoperative recovery.¹¹

In this study, the patients who received QIPB exhibited significantly lower pain scores, both at rest and during movement, compared to the control group. This was accompanied by a reduced need for rescue analgesia.

These findings align with previous studies that have demons-trated the positive impact of regional anaesthesia tech-niques such as the S-ESPB, PENG block, and suprainguinal fascia iliaca block (SFIB) on postoperative functional recovery, quality of life, and pain management in patients undergoing hip surgery.^4,19-22

Similarly, in this study, the application of QIPB resulted in lower early postoperative NRS scores and reduced opioid requirements. These findings align with previous reports attributing opioid-sparing effects and improved pain control to other regional block techniques.^19-22

Another fascial plane block that has gained popularity in recent years for hip and abdominal surgeries is the QLB. The posterolateral and transmuscular variants of the QLB aim to achieve analgesia by spreading local anaesthetic around the quadratus lumborum muscle to target thoracolumbar nerves. However, studies evaluating the use of QLB following THA have reported heterogeneous results.^23,24 Thus, QIPB was developed to overcome the limitations of QLB. Anatomical studies have shown that when QIPB is performed at the level of the iliac crest, the local anaesthetic spreads extensively along the anterior and posterior surfaces of the quadratus lumborum muscle. It also progresses along the transversalis fascia, staining components of the lumbar plexus, as well as the ilioinguinal, iliohypogastric, and subcostal nerves​.⁶

Through this extensive spread, QIPB achieves a nerve coverage comparable to that of a LPB, but via a more superficial fascial plane, potentially offering a safer and technically simpler approach. Indeed, a recent study reported that QIPB appli-cation in proximal femur surgeries resulted in significantly lower pain scores and reduced opioid requirements, with some patients requiring no opioids at all​.⁸ The LPB can provide effective analgesia by blocking both femoral and obturator nerves. However, its clinical use is limited due to its invasive nature and associated risks such as epidural spread and hypotension​.²⁵

Although QIPB is a newly described technique, it is performed within an anatomical plane that carries a low risk of major vascular or organ injury, thereby enhancing its safety profile. Ultrasound guidance further improves its safety by providing a clear view at the level of the iliac wings.¹⁴

In this study, nausea and vomiting were significantly more frequent in the control group, associated with higher tramadol consumption and an increased need for anti-emetics. Patients receiving QIPB reported higher satisfaction scores on the Likert scale. These findings suggest that QIPB reduces the risk of PONV and improves patient satisfaction. Consistent with the previous reports, no serious adverse effects such as hypo-tension, motor block, or PONV were observed following QIPB​.^14,15

This study has several limitations. First, the follow-up period was restricted to the initial 24 hours postoperatively; therefore, long-term outcomes such as chronic pain development, persistent functional impairment, or late complications could not be evaluated. Second, the study did not include a direct comparison between the QIPB and other regional tech- niques such as the PENG block, SFIB, or LPB. Future research should investigate the long-term efficacy and safety of QIPB and explore its comparative effectiveness and potential combinations with other blocks across different surgical popuLations.

CONCLUSION

The QIPB is a novel and effective regional analgesic tech-nique that offers significant postoperative pain relief, enhan- ces patient comfort and satisfaction, and contributes positively to the quality of recovery after THA.

ETHICAL  APPROVAL:
Ethical approval for this multicentre study was granted by the Clinical Research Ethics Committee of the Harran University Faculty of Medicine, Sanliurfa, Turkiye (Approval No. 25.02.15; Dated: 27 January 2025). In addition, institutional permission was obtained from the Konya City Hospital, Konya, Turkiye (Decision No. 01-65; Dated: 2 January 2025). The trial was prospectively registered at ClinicalTrials.gov (Identifier: NCT06870071).

PATIENTS’  CONSENT:
Written informed consent was obtained from all patients.

COMPETING  INTEREST:
The authors declared no conflict of interest.

AUTHORS’  CONTRIBUTION:
MHS, MST, BK, MY, AY, NA: Study conception, design, data collection, analysis, interpretation, drafting, review, project management, resources, software, supervision, verification, visualisation.
All authors approved the final version of the manuscript to be published.

REFERENCES

1. Classen T, Zaps D, Landgraeber S, Li X, Jager M. Assessment and management of chronic pain in patients with stable total hip arthroplasty. Int Orthop 2013; 37(1):1-7. doi: 10.1007/s00264-012-1711-6.
2. Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular nerve group (PENG) block for hip fracture. Reg Anesth Pain Med 2018; 43(8):859-63. doi: 10.1097/aap. 0000000000000847.
3. Laigaard J, Pedersen C, Ronsbo TN, Mathiesen O, Karlsen APH. Minimal clinically important differences in randomised clinical trials on pain management after total hip and knee arthroplasty: A systematic review. Br J Anaesth 2021; 126(5):1029-37. doi: 10.1016/j.bja.2021.01.021.
4. Satici MH, Tutar MS, Tire Y, Binici O, CiCekler O, Korkmaz E, et al. The effect of sacral erector spinae plane block on the quality of recovery after total hip arthroplasty: A prospective, randomized, controlled, multicenter study. Minerva Anestesiol 2025; 91(4):278-85. doi: 10.23736/ S0375-9393.24.18353-8.
5. Marty P, Chassery C, Rontes O, Vuillaume C, Basset B, Merouani M, et al. Combined proximal or distal nerve blocks for postoperative analgesia after total knee arthroplasty: A randomised controlled trial. Br J Anaesth 2022; 129(3): 427-34. doi: 10.1016/j.bja.2022.05.024.
6. Tulgar S, Ciftci B, Ahiskalioglu A, Bilal B, Sakul BU, Girit M, et al. Ultrasound-guided quadro-iliac plane block: Another novel fascial plane block. Pain Med 2024; 25(6):370-73. doi: 10.1093/pm/pnae018.
7. Elsharkawy H, El-Boghdadly K, Barnes TJ, Drake R, Maheshwari K, Soliman LM, et al. The supra-iliac anterior quadratus lumborum block: A cadaveric study and case series. Can J Anaesth 2019; 66(8):894-06. doi: 10.1007/ s12630-019-01312-z.
8. Turan EI, Baydemir AE, Sahin AS. Efficacy of the quadro-iliac plane block in postoperative pain management for proximal femoral nail surgeries. Minerva Anestesiol 2025; 91(3): 221-23. doi: 10.23736/S0375-9393.24.18506-9.
9. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340:c869. doi: 10.1136/bmj. c869.
10. Myles PS, Shulman MA, Reilly J, Kasza J, Romero L. Measurement of quality of recovery after surgery using the 15-item quality of recovery scale: A systematic review and meta-analysis. Br J Anaesth 2022; 128(6):1029-39. doi: 10.1016/j.bja.2022.03.009.
11. Myles PS, Myles DB. An updated minimal clinically important difference for the QoR-15 scale. Anesthesiology 2021; 135 (5):934-35. doi: 10.1097/ALN.0000000000003977.
12. Gao Y, Li H, Hu H, Xu Y, Zhou J, Liu Y. Effects of continuous fascia iliaca compartment block on early quality of recovery after total hip arthroplasty in elderly patients: A randomized controlled trial. J Pain Res 2022; 15:1837-44. doi: 10.2147/ JPR.S368285.
13. Ciftci B, Tulgar S, Sakul BU, Alver S, Alici HA. Inspiring use of novel blocks in chronic pain management: Quadro-iliac plane block a promising step toward the future-A case report. A A Pract 2024; 18(12):e01886. doi: 10.1213/XAA. 0000000000001886.
14. Satici MH, Altay N. Quadro-iliac plane block in inguinal hernia surgery. Minerva Anestesiol 2025; 91(5):475-6. doi: 10.23736/S0375-9393.25.18739-7.
15. Ciftci B, Cetinkal A, Alver S, Ahiskalioglu A. Quadro-iliac plane block for lumbar multi-level instrumentation surgery: Far away from the surgical area. Minerva Anestesiol 2025; 91(4):358-59. doi: 10.23736/S0375-9393.24.18680-4.
    
     
16. Turan EI, Guler H, Ozen V, Sahin AS. Quadroiliac plane block for postoperative pain management in a patient undergoing retrograde ıntrarenal surgery: A case report. A A Pract 2025; 19(3):e01925. doi: 10.1213/XAA.0000000000001925.
17. Kukreja P, Uppal V, Kofskey AM, Feinstein J, Northern T, Davis C, et al. Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: A randomised controlled observer-blinded trial. Br J Anaesth 2023; 130(6):773-9. doi: 10. 1016/j.bja.2023.02.017.
18. Xue FS, Yang WH, Li XY. Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia. Comment on Br J Anaesth 2023; 130:773-9. Br J Anaesth 2024; 132(5): 1176-77. doi: 10.1016/j.bja.2023.10.007.
19. Mendes E, Adiyeke O, Sarban O, Civan M, Ozcan FG. Timing of suprainguinal fascia iliaca block in hip hemiarthroplasty: Impact on QoR-15 scores–A prospective randomized study. BMC Anesthesiol 2025; 25(1):179. doi: 10.1186/s12871- 025-03060-8.
20. Braun AS, Lever JEP, Kalagara H, Piennette PD, Arumugam S, Mabry S, et al. Comparison of pericapsular nerve group (PENG) block versus quadratus lumborum (QL) block for analgesia after primary total hip arthroplasty under spinal anesthesia: A retrospective study. Cureus 2023; 15(12): e50119. doi: 10.7759/cureus.50119.
21. Andrade PP, Lombardi RA, Marques IR, Braga ACDNAE, Isaias BR, Heiser NE. Pericapsular nerve group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: A systematic review and meta-analysis of randomized controlled trials. Braz J Anesthesiol 2023; 73(6):794-09. doi: 10.1016/j.bjane.2023.07.007.
22. Marrone F, Fusco P, Tulgar S, Paventi S, Tomei M, Fabbri F, et al. Combination of pericapsular nerve group (PENG) and sacral erector spinae plane (S-ESP) blocks for hip fracture pain and surgery: A case series. Cureus 2024; 16(2): e53815. doi: 10.7759/cureus.53815.
23. Xiong H, Chen X, Zhu W, Yang W, Wang F. Postoperative analgesic effectiveness of quadratus lumborum block: Systematic review and meta-analysis for adult patients undergoing hip surgery. J Orthop Surg Res 2022; 17(1):282. doi: 10.1186/s13018-022-03172-8.
24. Rozier R, Loiseleur A, Ciais C, Moulin O, Alais B, Marguerite K, et al. Anterior quadratus lumborum block in total hip arthroplasty: A two-center, randomized, placebo-controlled trial showing no additional benefit over multimodal analgesia. Reg Anesth Pain Med 2025; 10:rapm-2024- 106247. doi: 10.1136/rapm-2024-106247.
25. AlMutiri WA, AlMajed E, Alneghaimshi MM, AlAwadh A, AlSarhan R, AlShebel MN, et al. Efficacy of continuous lumbar plexus blockade in managing post-operative pain after hip or femur orthopedic surgeries: A systematic review and meta-analysis. J Clin Med 2024; 13(11):3194. doi: 10. 3390/jcm13113194.