Analgesic Efficacy of Continuous S-ESP vs Continuous FICB After Hip Arthroplasty

Overview

The primary objective of this prospective, randomized, double-blind controlled trial is to compare the postoperative analgesic efficacy of continuous Sacral Erector Spinae Plane (S-ESP) block versus continuous Fascia Iliaca Compartment Block (FICB) in adult patients undergoing elective hip replacement surgery. The investigators hypothesize that the continuous S-ESP block will provide non-inferior or superior pain relief compared to continuous FICB, while potentially reducing the incidence of motor block and facilitating earlier postoperative mobilization. Participants will be randomly assigned to receive either an S-ESP or FICB catheter for continuous local anesthetic infusion over 48 hours postoperatively. Postoperative pain scores, opioid consumption, and functional recovery will be systematically evaluated.

Effective postoperative pain management is crucial for early rehabilitation, patient satisfaction, and enhanced recovery after hip replacement surgery. While the continuous Fascia Iliaca Compartment Block (FICB) is a well-established and widely used regional anesthesia technique for hip surgery, it is frequently associated with quadriceps weakness, which can significantly delay early ambulation and physical therapy. The continuous Sacral Erector Spinae Plane (S-ESP) block is a relatively novel, ultrasound-guided fascial plane block that targets the lumbar and sacral plexus branches. Recent literature suggests it offers profound sensory blockade with relative motor sparing, making it a highly attractive alternative for lower extremity surgeries. In this study, eligible patients scheduled for elective unilateral hip replacement surgery at Bach Mai Hospital will be randomly allocated into two parallel arms: the S-ESP group and the FICB group. Under ultrasound guidance, a catheter will be inserted into the respective fascial plane (sacral erector spinae plane or fascia iliaca compartment). A continuous infusion of local anesthetic will be administered via the catheter for 48 hours postoperatively. Both groups will receive a standardized multimodal systemic analgesia protocol. Rescue analgesia (intravenous opioids) will be provided on demand. A blinded outcome assessor will meticulously record static and dynamic pain scores, cumulative opioid consumption, the degree of motor blockade, time to first ambulation, and any procedure-related adverse events. The findings of this study will help determine if continuous S-ESP is a more optimal regional anesthesia strategy compared to the traditional continuous FICB for postoperative pain control in hip arthroplasty.