A Prospective randomized control trial to assess the role of Tensor Fascia Lata Plane Block in addition to Fascia Iliaca Compartment Block (FICB) using ultrasound in patient undergoing proximal femur surgeries through lateral incision of thigh.

The current practice in regional anesthesia for proximal femur surgeries with lateral incisions is the Fascia Iliaca Compartment Block (FICB) and the Pericapsular Nerve Group (PENG) block. The FICB is an anterior lumbar plexus block in which local anaesthetic is injected deep to the fascia iliaca with the aim of blocking the femoral nerve (FN) and lateral femoral cutaneous nerve (LFCN). The incisions for proximal femur surgeries also involve cutting through the tensor fascia lata (TFL) muscle which is supplied by the superior gluteal nerve which is a branch of the sciatic nerve, arising from the lumbosacral plexus. The superior gluteal nerve is not covered by the fascia iliaca block.By means of this thesis study, we aim to assess the benefits and feasibility of blocking the superior gluteal nerve by means of administering the Tensor Fascia Lata Plane Block in addition to FICB for proximal femur surgeries.

RECRUITMENT OF PATIENTS -During pre-anaesthetic check (Informed consent will be taken by

primary investigator, patient is randomised by double blinding technique before the procedure.

They are randomised into two groups GROUP A (Fascia Iliaca Compartment Block) and

GROUP B (Fascia Iliaca Compartment Block+ TFL Block)

Under sterile aseptic precaution the anterior and lateral regions of the thigh at the inguinal region and upper thigh will be painted and draped

The ultrasound linear, high frequency transducer probe will be draped with sterile cover and first placed at inguinal region.

The femoral vessels, illiacus and sartorius muscle will be identified. The probe will then be moved laterally till the tensor fascia lata muscle appears into view after sartorius insertion

The transducer will be moved further laterally and slightly downward the thigh to identify the fascial plane between the TFL and the gluteus Medius. The superior gluteal nerve along with its accompanying vessel – transverse branch of lateral circumflex femoral artery enters the TFL muscle through its lower border

At this point on the USG Sono anatomy .upon identifying the arterial pulsation at the lower border of the muscle ,the block needle will be inserted from the medial edge of the probe and advanced till the lower border of the TFL

Upon reaching this point, the probe is moved 0.5 – 1 cm cranially from the point of entry of the artery, and the drug will be injected after negative aspiration .The expected endpoints will be drug spread along tensor fascia lata and the gluteus Medius muscle

A single shot of 8-10 ml of 0.25% bupivacaine or 0.2% ropivacaine with 0.2mcg/kg of dexmedetomidine will be administered after confirmation of drug spread.