Femoral Rami Obturator Nerve Trunk (FRONT) Block in Intramedullary Nail Surgery .

Post operative pain levels after hip fracture are high during ambulation and may worsen outcome after hip fracture. Regional anesthesia has shown to facilitate rehabilitation in orthopedics procedures. Many of these regional anesthesia techniques ,such as femoral nerve, lumber plexus, peri capsular nerve group(PENG), fascia iliaca blocks have gained attention for their opioid and some times for motor sparing potential, as well as the ability to provide targeted analgesia for anterior hip joint. Nevertheless the anterior hip joint coverage needs the constant contribution of femoral and obturator nerves to provide adequate pain relieve. In this study patients will receive preoperative femoral rami obturator nerve trunk(FRONT) block , a novel regional anesthesia technique described by Jessen et al., as a promising solution to the long-standing challenge of anesthetizing both the femoral and obturator nerve branches in anterior hip joint for postoperative pain control, addressing a more comprehensive coverage of anterior hip innervation.

Note: The protocol was amended prior to enrollment of the reported cohort. The control group was changed from multimodal analgesia alone to a sham block procedure; the primary outcome was changed from postoperative NRS pain score to time to first analgesic request; motor assessment was expanded from the Modified Bromage scale to include Manual Muscle Testing (MRC scale) and straight leg raise.

Inclusion criteria

• the elderly age≥60 years
• American Society of Anesthesiologists (ASA) classification 1-2
• patients who undergoing surgery for intramedullary nail surgery.

Exclusion criteria

• patient refused to participate and consent
• patients with a history of mild cognitive impairment (MCI), dementia, and delirium
• patients with known preoperative infections (pulmonary infection, urinary infection, and sepsis).
• coagulopathy