This study will evaluate whether ultrasound-guided quadro-iliac plane block provides better postoperative pain control than local infiltration analgesia in patients undergoing single-level lumbar microdiscectomy.
Adult patients scheduled for elective single-level lumbar microdiscectomy will be randomly assigned to receive either bilateral quadro-iliac plane block plus patient-controlled analgesia or local infiltration analgesia plus patient-controlled analgesia. The main outcome of the study will be total fentanyl consumption during the first 24 hours after surgery. Pain scores, need for rescue analgesia, opioid-related side effects, patient satisfaction, and recovery quality will also be evaluated.
Adults aged 18 to 75 years
American Society of Anesthesiologists physical status I to III
Scheduled for elective single-level lumbar microdiscectomy, such as L4-L5 or L5-S1 disc herniation
Planned surgery under general anesthesia
Allergy or hypersensitivity to local anesthetics
Coagulopathy or active anticoagulant use
Infection, scar tissue, or skin lesion at the injection site
Pregnancy or breastfeeding
Parallel
Ultrasound-Guided Quadro-Iliac Plane Block
Procedure/SurgeryBilateral ultrasound-guided quadro-iliac plane block will be performed before emergence from general anesthesia in the prone position. After visualization of the quadratus lumborum muscle and iliac crest at the L3 level, 30 mL of 0.167% bupivacaine will be injected into the interfascial plane on each side. All participants will receive postoperative fentanyl-based patient-controlled analgesia.
Local Infiltration Analgesia (LIA)
Procedure/SurgeryLocal infiltration analgesia will be performed by the surgeon before the end of surgery. A total dose of 50 mg of 0.25% bupivacaine will be infiltrated into the subcutaneous tissue. All participants will receive postoperative fentanyl-based patient-controlled analgesia.
Total Fentanyl Consumption During the First 24 Hours After Surgery
Total postoperative fentanyl consumption administered via patient-controlled analgesia will be recorded during the first 24 hours after surgery.
Postoperative Pain Scores at Rest and During Movement
Pain intensity will be assessed using the Numerical Rating Scale at rest and during movement. The scale ranges from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain.
Number of Patients Require Rescue Analgesic
The need for rescue analgesia with intravenous tenoxicam will be recorded during the postoperative follow-up period.
Opioid-Related Adverse Effects
Opioid-related adverse effects, including nausea, vomiting, pruritus, and respiratory depression, will be recorded.
Quality of Recovery Score
Patient-reported recovery quality will be assessed using the Quality of Recovery-15 questionnaire (0-150). Higher value means better Quality of Recovery.
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