Comparison of ultrasound-guided suprainguinal fascia iliaca block and lumbar erector spinae plane block in hip fracture: A single-blind randomized controlled trial

Objective: Hip fractures are common in older adults and are associated with increased morbidity and mortality. Although multimodal anesthesia with peripheral nerve blocks is recommended, the superiority of specific block methods remains unclear. This study compared the postoperative analgesic efficacy of the suprainguinal fascia iliaca block (SFIB) and lumbar erector spinae plane block (LESPB) in patients who underwent hip fracture surgery. Material and Methods: This single-center, single-blind, randomized controlled trial was conducted at a university hospital (Marmara University Faculty of Medicine, İstanbul, Türkiye) between August 2022 and May 2023. Patients received SFIB, LESPB, or no block before spinal anesthesia. No block-related complications were observed. Postoperative analgesia was provided using patient-controlled intravenous morphine, with tramadol administered as rescue analgesia for NRS pain scores above 4. The primary outcome was 24-hour total opioid consumption. Secondary outcomes included opioid consumption at 6 and 48 hours, pain scores, rescue analgesia requirements, and time to discharge from the intensive care unit and hospital. Results: A total of 63 patients (mean age 78.5±14.0 years; 46 females and 17 males) with American Society of Anesthesiologists I-III undergoing hip fracture surgery were randomized to SFIB (n=23), LESPB (n=22), or control (n=22). During the first 24 hours, opioid consumption were higher in the control group [18 (9-24.5); p=0.002]. Post-hoc analysis showed a significant difference between the control and SFIB groups [6 (4-9); p<0.001]. The LESPB [13 (5-22)] and control groups were comparable (p>0.016). Conclusion: SFIB provided the greatest reduction in postoperative opioid use during the first 24 hours after hip fracture surgery. While LESPB appears to be an alternative to SFIB, it produced a reduction in opioid consumption similar to that observed in the control group. Suprainguinal FIB should be prioritized as a component of multimodal analgesia for these surgeries.