Comparison of Analgesic Efficacy of Suprainguinal Fascia Iliaca and Quadro-iliac Blocks in Hip Fracture Surgery

Post Operative Pain

Hip Fracture, Suprainguinal Fascia Iliaca Block, Quadro-Iliac Plane Block

This prospective, randomized, double-masked trial compared two ultrasound-guided regional analgesic techniques, suprainguinal fascia iliaca block (SIFI) and quadro-iliac plane block (QIPB), in adults undergoing surgery for hip fracture under spinal anesthesia. The primary outcome was pain at rest and during movement, assessed using a 0-10 numeric rating scale during the first 24 hours after complete resolution of spinal motor block (Bromage score 0). Secondary outcomes included postoperative opioid consumption, rescue analgesic requirements, nausea and vomiting, quality of recovery, time to first assisted standing and other recovery measures, and patient satisfaction. Both groups received the same postoperative multimodal analgesic regimen. Eighty-five participants were randomized, and 70 participants completed follow-up and were included in the reported analysis.

This prospective, parallel-group randomized trial compared two ultrasound-guided blocks in adults undergoing hip fracture surgery under spinal anesthesia. Participants and postoperative outcome assessors were masked; the anesthesiologist performing the block knew the assigned technique. Eighty-five participants were randomized (43 SIFI and 42 QIPB), and 35 per group were included in the reported analysis after post-randomization exclusions. Different surgical procedures for hip fracture were included; procedure type was not used for subgroup analysis. Both blocks were performed before spinal anesthesia using a linear ultrasound probe and an 80-mm peripheral block needle. SIFI was performed supine, with injection deep to fascia iliaca over the iliacus muscle and suprainguinal spread. QIPB targeted the fascial plane related to the posterior surface of quadratus lumborum at its attachment to the iliac crest. QIPB was performed prone, or in lateral decubitus when pain prevented tolerance of prone positioning. Both blocks used 40 mL of 0.25% bupivacaine (100 mg). The peripheral block dose limit was 2 mg/kg; no dose reduction was required. Spinal anesthesia used 12.5 mg of 0.5% hyperbaric bupivacaine. Both groups received intravenous paracetamol 1 g every eight hours and tramadol patient-controlled analgesia (10-mg bolus, 20-minute lockout, no background infusion, maximum 400 mg per day). Rescue analgesia was 25 micrograms of intravenous fentanyl if either rest or movement pain exceeded 4 on the numeric rating scale. Rescue doses were recorded separately from patient-controlled analgesia button presses. Pain was reassessed at the next scheduled assessment, with further rescue analgesia when required. Time zero was complete resolution of spinal motor block (Bromage score 0). Rest and movement pain were assessed at 0, 1, 3, 6, 12, 18 and 24 hours from time zero. Movement was defined as changing from a lying to a sitting position. Opioid consumption and rescue analgesia were assessed within the same 24-hour window. Tramadol and fentanyl doses were recorded separately and summarized as approximate intravenous morphine equivalents. The Turkish QoR-15 was administered before surgery and 24 hours after time zero; higher scores indicate better recovery. First assisted standing, first oral intake and first passage of either flatus or stool were timed from time zero. Satisfaction was rated from 1 to 10. The first participant was enrolled on May 4, 2026. Final primary outcome assessments and all study follow-up were completed on September 13, 2026.

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Turkey (Türkiye)