Comparison of Sacral Erector Spinae Plane Block and Supra-Inguinal Fascia Iliaca Block for Analgesia After Hip Fracture Surgery

Hip fractures are common injuries among elderly patients, often resulting in high rates of morbidity and mortality. Effective postoperative pain management plays a critical role in reducing complications such as delayed mobilization, deep vein thrombosis, pneumonia, and prolonged hospitalization.

Regional anesthesia techniques, including Sacral Erector Spinae Plane Block (SESPB) and Supra-Inguinal Fascia Iliaca Block (SIFIB), have gained popularity as part of multimodal analgesia strategies that aim to minimize opioid use and improve postoperative comfort. However, there is limited evidence comparing these two techniques directly.

In this prospective observational study, patients aged 65 and older undergoing hip fracture surgery under spinal anesthesia were included. After obtaining informed consent, patients received either SESPB or SIFIB for postoperative analgesia in addition to the standard anesthetic protocol.

Pain levels were assessed using the Visual Analog Scale (VAS) at 1, 6, 12, and 24 hours after surgery. Additional data such as total opioid consumption within 24 hours, time to first analgesic requirement, mobilization time, and length of hospital stay were recorded.

The results demonstrated that patients who received SIFIB had significantly lower pain scores in the early postoperative period (1st hour), while patients who received SESPB experienced better pain relief in the late postoperative period (24th hour). No significant differences were observed between the groups in terms of total opioid consumption, mobilization time, or hospital stay duration. No complications related to the block procedures were reported.

This study suggests that both SESPB and SIFIB are safe and effective regional anesthesia techniques for postoperative pain management in hip fracture surgeries. The selection between these blocks may be based on the desired onset and duration of analgesia, with SIFIB providing superior early pain control and SESPB offering more prolonged analgesic effects.

Inclusion criteria

• Patients aged 65 years and older
• Patients undergoing surgery for hip fractures under spinal anesthesia
• Patients who are oriented and cooperative
• Patients who have signed an informed consent form

Exclusion criteria

• Patients with contraindications for spinal anesthesia
• Patients with Alzheimer's disease or dementia, and those who are non-oriented or non-cooperative
• Patients with major organ failure (such as heart, liver, or kidney failure)
• Patients who decline to participate in the study
• Patients classified as American Society of Anesthesiologists (ASA) Physical Status IV or higher
• Patients with pathological fractures or bone metastasis