Abstract / Summary
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.