Circum-Psoas Blocks Versus Combined Lumbar and Sacral Plexus Blocks in Hip Fracture Surgery

Hip fracture (HF) is one of the major worldwide problems that constitute a significant mortality rate, ranging from 14- 36% in the first year after injury, and is associated with profound temporary and sometimes permanent impairment of independence and quality of life in the geriatric population. Surgical treatment is considered the best option for patients with hip fractures,s especially in the elderly, however, it is associated with moderate to severe postoperative pain.Pain is one of the main factors limiting ambulation, increasing the risk of thromboembolism by immobility and causing metabolic changes that affect other systems. Therefore, individualized pain management with the use of appropriate analgesic techniques is of paramount importance. Moreover, early intervention of rehabilitation aiming at a better postoperative recovery may reduce the length of hospital stay and return to daily. Effective pain management is one of the crucial components in enhanced recovery after surgery (ERAS).• Numerous regional anesthetic techniques have been used to provide analgesia following hip fracture surgery, including intrathecal morphine, epidural analgesia, fascia iliaca block, lumber plexus block, and sacral plexus block, however, each of these techniques has specific limitations that prevent them from being the analgesic technique of choice for hip fracture surgery.To our knowledge, there is no study done to compare circum-psoas block versus the combined lumbar and sacral plexus blocks as pre-emptive analgesia in patients undergoing hip fracture surgery under general anesthesia.

Inclusion Criteria:Patient acceptance.BMI ≤ 30 kg/m2ASA I-III.First unilateral surgery for hip fracture including femoral neck, intertrochanteric or subtrochanteric fracture.Patient with planned hip fracture surgery within 24-72 hours under general anesthesia.Exclusion Criteria:Multiple trauma, multiple fractures, or pathological fracturesProsthetic fracture or usage of bone-cement fixation in the surgery.Scheduled for bilateral hip fracture surgery.Pre-existing neurological deficit in the lower extremityContraindication for peripheral nerve block (infection at the site of needle insertion, coagulopathy, allergy to local anesthetics used)History of chronic pain and taking analgesicsHistory of cognitive dysfunction or mental illness