When Distance Matters: The Quadro-iliac Plane Block in Complex Multilevel Posterior Spinal Fusion Surgery

Complex multilevel spinal surgeries are associated with severe postoperative pain due to extensive paraspinal muscle dissection, prolonged operative time, and multilevel instrumentation.Consistent with our prior institutional experience and the literature, patients undergoing multilevel spinal fusion without regional analgesia demonstrate an increased need for rescue opioid analgesia. 1Although several regional techniques have been proposed, effective options that do not interfere with the surgical field remain limited.Thoracolumbar interfascial plane and erector spinae plane (ESP) blocks are commonly used; however, their efficacy may be compromised in multilevel procedures where surgical trauma, edema, and instrumentation disrupt local anatomy and impair local anaesthetic spread.