Analgesic Efficacy of Ultrasound-Guided Deep Iliacus Plane Block in Patients Undergoing Hip Fracture Surgery

Hip fracture surgery is commonly associated with moderate to severe postoperative pain, which may delay mobilization and increase the need for opioid analgesics. The deep iliacus plane block is a recently described ultrasound-guided regional anesthesia technique designed to provide analgesia by allowing local anesthetic spread toward the femoral nerve, lateral femoral cutaneous nerve, and articular branches supplying the hip. This prospective, randomized, double-blind, sham-controlled clinical trial will evaluate the analgesic efficacy of the deep iliacus plane block in adult patients undergoing hip fracture surgery under spinal anesthesia. After surgery, participants will be randomly assigned to receive either an ultrasound-guided deep iliacus plane block with local anesthetic or a sham block with normal saline. All participants will receive standardized multimodal postoperative analgesia, including patient-controlled analgesia. The primary objective is to determine whether the deep iliacus plane block reduces postoperative opioid consumption during the first 24 hours after surgery. Postoperative pain scores, rescue analgesic requirements, sensory distribution, motor block, nausea and vomiting, quality of recovery, patient satisfaction, and block-related complications will also be evaluated.

Inclusion Criteria: * Age 18 years or older * Scheduled to undergo unilateral hip fracture surgery under spinal anesthesia * American Society of Anesthesiologists (ASA) physical status I-III * Ability to understand and use the Numerical Rating Scale and patient-controlled analgesia device * No contraindication to spinal anesthesia or the deep iliacus plane block * Written informed consent provided by the participant or legally authorized representative Exclusion Criteria: * ASA physical status IV or higher * Emergency surgery * Coagulopathy, bleeding diathesis, or anticoagulant treatment that contraindicates spinal anesthesia or peripheral nerve block * Infection at the planned needle insertion site * Known allergy to local anesthetics or any study medication * Pre-existing peripheral neuropathy, neurological disorder, or motor deficit involving the operated lower extremity * Inability to understand or use the Numerical Rating Scale or patient-controlled analgesia device * Cognitive impairment or communication difficulty preventing reliable postoperative assessment * Refusal to participate