Fascia Iliaca vs Femoral Nerve Block in Hip Fracture Patients

Overview

Hip fractures are common orthopedic injuries, especially in older adults, and surgical repair such as hip arthroplasty is often required. Effective pain control is essential in these patients to allow proper positioning for spinal anesthesia, reduce patient discomfort, and improve overall perioperative outcomes. Two commonly used regional anesthesia techniques for pain relief in hip fracture patients are the Fascia Iliaca Compartment Block (FICB) and the Femoral Nerve Block (FNB). Both techniques aim to block pain signals from the femoral nerve and related nerves supplying the hip region. However, there is ongoing debate regarding which technique provides better analgesia during positioning for spinal anesthesia. This study is a prospective, randomized controlled trial conducted at Central Park Teaching Hospital, Lahore. A total of 80 patients scheduled for hip arthroplasty will be enrolled and randomly divided into two equal groups. Group A will receive Fascia Iliaca Compartment Block, while Group B will receive Femoral Nerve Block. All patients will subsequently undergo spinal anesthesia as part of standard surgical care. The primary objective of the study is to compare the effectiveness of FICB and FNB in reducing pain during patient positioning for spinal anesthesia. Pain will be measured using the Numeric Rating Scale (NRS), which is a standard 0-10 pain scoring system, assessed before the nerve block and during positioning for spinal anesthesia. Standard monitoring will be used in all patients, including blood pressure, pulse oximetry, and electrocardiography. Both techniques will be performed using standard local anesthetic agents. Rescue analgesia will be provided if required to ensure patient safety and comfort. Data will be analyzed using appropriate statistical methods, and pain scores will be compared between the two groups. A p-value of ≤0.05 will be considered statistically significant. The study aims to determine which regional anesthesia technique provides superior analgesia during spinal anesthesia positioning in hip fracture patients. The findings may help improve pain management strategies, enhance patient comfort, and optimize perioperative care in orthopedic surgery.

Hip fractures represent a major cause of morbidity in orthopedic practice, particularly among elderly patients. Surgical management, including hemiarthroplasty or total hip arthroplasty, is frequently required to restore mobility and reduce complications associated with prolonged immobilization. Effective perioperative pain control is essential in these patients, not only to improve comfort but also to facilitate optimal positioning for neuraxial anesthesia and to reduce perioperative physiological stress responses. Spinal anesthesia is widely preferred over general anesthesia in hip fracture surgery due to its advantages, including reduced intraoperative blood loss, lower risk of thromboembolic events, and better postoperative analgesia. However, positioning patients with acute hip fractures for spinal anesthesia is often challenging due to severe pain, which can lead to patient discomfort, hemodynamic instability, and difficulty in performing the procedure. Adequate pre-procedural analgesia is therefore essential. Regional nerve blocks have emerged as an effective strategy for providing analgesia in hip fracture patients. Among these, the Fascia Iliaca Compartment Block (FICB) and the Femoral Nerve Block (FNB) are commonly used techniques. Both approaches aim to block sensory input from the femoral nerve and associated branches supplying the anterior thigh and hip region. Despite their widespread use, there is ongoing debate regarding their relative effectiveness, particularly in terms of pain control during positioning for spinal anesthesia. FICB is a fascial plane block that targets the femoral nerve, lateral femoral cutaneous nerve, and occasionally the obturator nerve by depositing local anesthetic beneath the fascia iliaca. It is considered relatively easier to perform and may provide broader sensory coverage. In contrast, FNB is a more targeted nerve block that specifically anesthetizes the femoral nerve. While FNB may provide effective analgesia, its narrower coverage may limit its efficacy in certain clinical scenarios involving hip fractures. This study is designed as a prospective, randomized, controlled clinical trial conducted at the Orthopedics Operation Theatre of Central Park Teaching Hospital, Lahore. A total of 80 patients scheduled for elective hip arthroplasty will be enrolled after meeting eligibility criteria. Participants will be randomly allocated into two equal groups using a lottery-based randomization method. Group A will receive Fascia Iliaca Compartment Block, while Group B will receive Femoral Nerve Block. All patients will subsequently undergo standard spinal anesthesia as part of routine surgical care. Both interventions will be performed under standard aseptic conditions using established anatomical landmark techniques. A uniform local anesthetic solution will be administered in both groups to ensure comparability. Standard intraoperative monitoring, including non-invasive blood pressure, electrocardiography, and pulse oximetry, will be applied to all patients throughout the procedure. The primary outcome measure of this study is the comparison of pain scores during positioning for spinal anesthesia between the two groups. Pain will be assessed using the Numeric Rating Scale (NRS), a validated 11-point scale ranging from 0 (no pain) to 10 (worst possible pain). Pain assessments will be recorded prior to nerve block administration and during patient positioning for spinal anesthesia. Secondary outcomes include baseline pain scores before intervention, adequacy of sensory block assessed by pinprick and cold sensation testing, and requirement for rescue analgesia if pain exceeds acceptable thresholds. Rescue analgesia, if required, will be administered using intravenous nalbuphine in standardized doses to ensure patient comfort and safety. Data will be collected using a structured proforma and entered into SPSS version 25 for statistical analysis. Continuous variables will be expressed as mean and standard deviation, while categorical variables will be reported as frequencies and percentages. Independent sample t-tests will be used to compare mean pain scores between groups. Chi-square tests may be applied for categorical variables where appropriate. A p-value of ≤0.05 will be considered statistically significant. Stratified analysis will be performed based on age, gender, and body mass index to control for potential confounding factors. This will help assess the consistency of analgesic efficacy across different patient subgroups. Ethical approval for the study has been obtained from the institutional ethics committee of Central Park Teaching Hospital, Lahore. Written informed consent will be obtained from all participants prior to enrollment. Patient confidentiality will be strictly maintained throughout the study, and participation will not interfere with standard clinical care. The findings of this study are expected to contribute valuable evidence regarding the comparative effectiveness of Fascia Iliaca Compartment Block and Femoral Nerve Block in hip fracture patients. The results may assist anesthesiologists and orthopedic surgeons in selecting the most effective regional anesthesia technique for improving patient comfort and facilitating spinal anesthesia positioning.