Hip fracture surgery is commonly associated with moderate to severe postoperative pain, which may delay mobilization and increase the need for opioid analgesics. The deep iliacus plane block is a recently described ultrasound-guided regional anesthesia technique designed to provide analgesia by allowing local anesthetic spread toward the femoral nerve, lateral femoral cutaneous nerve, and articular branches supplying the hip.
This prospective, randomized, double-blind, sham-controlled clinical trial will evaluate the analgesic efficacy of the deep iliacus plane block in adult patients undergoing hip fracture surgery under spinal anesthesia. After surgery, participants will be randomly assigned to receive either an ultrasound-guided deep iliacus plane block with local anesthetic or a sham block with normal saline.
All participants will receive standardized multimodal postoperative analgesia, including patient-controlled analgesia. The primary objective is to determine whether the deep iliacus plane block reduces postoperative opioid consumption during the first 24 hours after surgery. Postoperative pain scores, rescue analgesic requirements, sensory distribution, motor block, nausea and vomiting, quality of recovery, patient satisfaction, and block-related complications will also be evaluated.
Inclusion Criteria:
Exclusion Criteria:
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Participants and postoperative outcome assessors will be masked to group allocation. Both groups will undergo an identical ultrasound-guided deep iliacus plane block procedure. The anesthesiologist performing the block will be aware of the allocated intervention but will not participate in postoperative outcome assessment. Group allocation will remain concealed from participants and outcome assessors until completion of data collection, except when emergency unmasking is required for participant safety.
Participants assigned to this group will receive an ultrasound-guided unilateral deep iliacus plane block on the surgical side after completion of hip fracture surgery. The block will be performed using 30 mL of 0.25% bupivacaine. All participants will also receive standardized spinal anesthesia and multimodal postoperative analgesia, including intravenous patient-controlled analgesia with tramadol.
Participants assigned to this group will undergo an identical ultrasound-guided deep iliacus plane block procedure on the surgical side and will receive 30 mL of normal saline as a sham intervention. All participants will also receive standardized spinal anesthesia and the same multimodal postoperative analgesic regimen, including intravenous patient-controlled analgesia with tramadol.
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FASCIA ILIACA BLOCK VERSUS INTRAVENOUS NALBUPHINE AS ANALGESIC METHOD BEFORE POSITIONING FOR SPINAL ANESTHESIA IN PATIENTS UNDERGOING SURGERY FOR HIP FRACTURES