Turkish Journal of
GERIATRICS

¹Health Science University Basaksehir Cam and Sakura City Hospital, Department of Anesthesiology, Ä°stanbul, Turkiye
²Health Science University Kanuni Sultan Süleyman Education and Training Hospital, Department of Anesthesiology, Ä°stanbul, Turkiye
³Health Science University Seyrantepe Hamidiye Etfal Education and Training Hospital, Department of Anesthesiology, Ä°stanbul, Turkiye DOI : 10.29400/tjgeri.2026.496 Introduction: Pain control after proximal femoral nail surgery remains difficult, especially in older adults. The pericapsular nerve group block provides anterior hip analgesia, whereas the quadroiliac plane block may offer broader coverage. This study compared their postoperative analgesic efficacy in patients undergoing proximal femoral nail surgery under spinal anesthesia. Materials and Method: In this prospective, randomized, multicenter, non-inferiority trial, 52 patients were included. At the end of surgery, patients received either quadroiliac plane block or pericapsular nerve group block. All patients received standardized spinal anesthesia and multimodal postoperative analgesia, including intravenous patient-controlled tramadol. The primary outcome was cumulative tramadol consumption at 24 postoperative hours. Secondary outcomes were pain intensity, quality of recovery, postoperative nausea and vomiting, rescue analgesic requirement, and adverse events. Non-inferiority was assessed using the mean between-group difference in 24- hour tramadol consumption with bias-corrected and accelerated 95 percent confidence intervals. Results: Mean tramadol consumption at 24 hours was 67.7 milligrams in the quadroiliac plane block group and 81.5 milligrams in the pericapsular nerve group block group. The mean difference was minus 13.8 milligrams. Because the upper bound of the confidence interval did not exceed the prespecified non-inferiority margin of 32 milligrams, quadroiliac plane block was considered non-inferior. Overall, pain and quality of recovery were similar between groups. Postoperative nausea and vomiting occurred less frequently in the quadroiliac plane block group. No adverse events or motor weakness were observed. Conclusions: Quadroiliac plane block provided non-inferior postoperative analgesia compared with pericapsular nerve group block after proximal femoral nail surgery under spinal anesthesia. Keywords : Hip Fractures; Nerve Block; Postoperative Pain; Anesthesia, Spinal