P092 Opioid-sparing analgesia after cesarean delivery using the novel quadro-iliac plane (QIP) block: a clinical case

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Background and Aims Cesarean section (CS) is associated with moderate to severe postoperative pain. If intrathecal morphine is not used, fascial plane blocks, such as transversus abdominis plane or quadratus lumborum (QL) blocks, have the potential to improve analgesia following caesarean delivery. The Quadro Iliac Plane (QIP) block is a novel regional anesthesia technique involving injection of the local anesthetic at the posterior aspect of the QL muscle, near its attachment to the inner surface of the iliac crest, in the inter-muscular plane between the erector spinae and QL muscles. The QIP block enables effective blockade of the lower lumbar nerves, providing lumbo-sacral, abdominal, and hip analgesia. Methods A 35-year-old female (ASA II, BMI 22.0) underwent an elective CS (Pfannenstiel incision) under spinal anesthesia (L1-L2 level, ropivacaine 10 mg). Aseptically, a single-shot bilateral ultrasound-guided QIP block was performed postoperatively, administering 0.2% ropivacaine 25 ml on each side. (figure 1) Intravenous paracetamol at fixed times (3 g per day) was prescribed as a standard measure with provision for rescue analgesia (intravenous ketorolac or tramadol if NRS > 5). Written informed consent was obtained from the patient for the anesthesia plan, block placement, and this report’s publication. Results After spinal anesthesia wore off, sensory testing revealed T10 to L4 dermatome coverage. Pain assessment (Numerical Rating Scale [NRS]) showed analgesia at rest and during movement: NRS 1/2 at 6 and 12 hours, peaking at 2/5 at 24 hours, and returning to 0/0 at 48 hours. No motor block or side effects were observed. Hemodynamic parameters remained stable. Rescue analgesia was required at 24 hours postoperatively (ketorolac 30 mg). Early mobilization was achieved at 8 hours, and full mobilization by 24 hours. No complications or side effects were recorded. Conclusions This case highlights the QIP block as an opioid-sparing technique providing effective postoperative analgesia in CS.

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