Comparison of Sacral Erector Spinae Plane Block and Supra-Inguinal Fascia Iliaca Block for Analgesia After Hip Fracture Surgery

Prof. Dr. Cemil Tascıoglu Education and Research Hospital Organization77 enrolled

Overview

This study compares the postoperative analgesic effectiveness of Sacral Erector Spinae Plane Block (SESPB) and Supra-Inguinal Fascia Iliaca Block (SIFIB) in patients undergoing hip fracture surgery. Both techniques are regional anesthesia methods aiming to reduce postoperative pain and opioid consumption. The study evaluates pain scores, opioid requirements, mobilization times, and hospital discharge times to determine which block provides more effective pain management in different postoperative periods.

Hip fractures are common injuries among elderly patients, often resulting in high rates of morbidity and mortality. Effective postoperative pain management plays a critical role in reducing complications such as delayed mobilization, deep vein thrombosis, pneumonia, and prolonged hospitalization. Regional anesthesia techniques, including Sacral Erector Spinae Plane Block (SESPB) and Supra-Inguinal Fascia Iliaca Block (SIFIB), have gained popularity as part of multimodal analgesia strategies that aim to minimize opioid use and improve postoperative comfort. However, there is limited evidence comparing these two techniques directly. In this prospective observational study, patients aged 65 and older undergoing hip fracture surgery under spinal anesthesia were included. After obtaining informed consent, patients received either SESPB or SIFIB for postoperative analgesia in addition to the standard anesthetic protocol. Pain levels were assessed using the Visual Analog Scale (VAS) at 1, 6, 12, and 24 hours after surgery. Additional data such as total opioid consumption within 24 hours, time to first analgesic requirement, mobilization time, and length of hospital stay were recorded. The results demonstrated that patients who received SIFIB had significantly lower pain scores in the early postoperative period (1st hour), while patients who received SESPB experienced better pain relief in the late postoperative period (24th hour). No significant differences were observed between the groups in terms of total opioid consumption, mobilization time, or hospital stay duration. No complications related to the block procedures were reported. This study suggests that both SESPB and SIFIB are safe and effective regional anesthesia techniques for postoperative pain management in hip fracture surgeries. The selection between these blocks may be based on the desired onset and duration of analgesia, with SIFIB providing superior early pain control and SESPB offering more prolonged analgesic effects.

Study Type

OBSERVATIONAL

Interventions

Supra-inguinal Fascia Iliaca Block (SIFIB)PROCEDURE

Ultrasound-guided injection of 40 mL of 0.25% bupivacaine between the iliacus muscle and fascia iliaca via a supra-inguinal approach, performed preoperatively for postoperative analgesia in patients undergoing hip fracture surgery under spinal anesthesia.

Sacral Erector Spinae Plane Block (SESPB)PROCEDURE

Ultrasound-guided injection of 40 mL of 0.25% bupivacaine into the fascial plane deep to the erector spinae muscle at the sacral level (S2), performed preoperatively for postoperative analgesia in patients undergoing hip fracture surgery under spinal anesthesia.

Eligibility

Sex: ALLMin age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients aged 65 years and older * Patients undergoing surgery for hip fractures under spinal anesthesia * Patients who are oriented and cooperative * Patients who have signed an informed consent form Exclusion Criteria: * Patients with contraindications for spinal anesthesia * Patients with Alzheimer's disease or dementia, and those who are non-oriented or non-cooperative * Patients with major organ failure (such as heart, liver, or kidney failure) * Patients who decline to participate in the study * Patients classified as American Society of Anesthesiologists (ASA) Physical Status IV or higher * Patients with pathological fractures or bone metastasis

Outcomes

Primary Outcomes

Postoperative Pain Scores

Pain intensity measured using the Visual Analog Scale (VAS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst pain imaginable. Pain scores will be recorded at specific postoperative time points: 1st, 6th, 12th, and 24th hours.

Time frame: At 1 hour, 6 hours, 12 hours, and 24 hours postoperatively.

Time to First Postoperative Analgesic Requirement

Time interval from end of surgery to the first request for analgesia.

Time frame: Up to 48 hours postoperatively.

Total Postoperative Opioid Consumption

The total amount of opioids required by patients during the postoperative period.

Time frame: A week

Time to First Mobilization

The time until patients' first mobilization (walking or standing) after surgery.

Time frame: From the end of surgery until first mobilization, typically within 24 to 48 hours postoperatively

Secondary Outcomes

Length of Hospital Stay

Duration from the day of surgery to the day of hospital discharge, measured in calendar days.

Time frame: Up to 14 days postoperatively.

Block-Related Complications

Possible complications following Sacral Erector Spinae Plane Block (SESPB) and Supra-Inguinal Fascia Iliaca Block (SIFIB), such as nerve injury, infection, hematoma, etc.