Fascia iliaca block versus lumbar erector spinae plane block for analgesia in elderly patients with hip fractures: A prospective exploratory observational study

Study objective To compare the analgesic efficacy of lumbar erector spinae plane block (ESPB) and fascia iliaca block (FIB) in elderly patients undergoing surgery for hip fractures. Design Prospective, exploratory, observational study. Setting Orthopedic Departments of a major Italian hospital (AORN Antonio Cardarelli, Naples). Patients Fifty patients aged ≥65 years (31 FIB, 19 ESPB) scheduled for hip fracture surgery. Intervention Preoperative ultrasound-guided FIB or lumbar ESPB with 30 mL of 0.25% ropivacaine, followed by standardized spinal anesthesia with 10 mg of 0.5% ropivacaine. Measurements The primary outcome was postoperative pain intensity assessed using the Numeric Rating Scale (NRS) at 12, 24, and 48 h. Secondary outcomes included time to first rescue analgesia, time to mobilization, return of bowel function, and adverse events within 48 h. Main results Baseline characteristics were comparable between groups. Postoperative NRS pain scores showed no statistically significant differences at rest or during mobilization at any time point. At 12 h, median NRS at rest was 1 for FIB and 0 for ESPB ( p = 0.331), and during mobilization was 4 and 2, respectively ( p = 0.236). However, the temporal distribution of the first rescue analgesic request differed significantly ( p = 0.001); requests occurred earlier in the FIB group (48% within 12 h), whereas the ESPB group showed a more gradual distribution (37% requested between 12 and 24 h). All patients achieved early mobilization within 48 h. Adverse events were infrequent and comparable. Conclusion FIB and lumbar ESPB provide similar overall postoperative pain control and safety in elderly patients undergoing hip fracture surgery. ESPB may offer a more gradual analgesic profile, though procedural positioning challenges must be balanced against FIB's ease of supine execution.