Comparative Study of Fascia Iliaca Block Versus Femoral Nerve Block for Postoperative Pain Management in Hip Fractures

Hip fractures represent a major cause of morbidity in orthopedic practice, particularly among elderly patients. Surgical management, including hemiarthroplasty or total hip arthroplasty, is frequently required to restore mobility and reduce complications associated with prolonged immobilization. Effective perioperative pain control is essential in these patients, not only to improve comfort but also to facilitate optimal positioning for neuraxial anesthesia and to reduce perioperative physiological stress responses.

Spinal anesthesia is widely preferred over general anesthesia in hip fracture surgery due to its advantages, including reduced intraoperative blood loss, lower risk of thromboembolic events, and better postoperative analgesia. However, positioning patients with acute hip fractures for spinal anesthesia is often challenging due to severe pain, which can lead to patient discomfort, hemodynamic instability, and difficulty in performing the procedure. Adequate pre-procedural analgesia is therefore essential.

Regional nerve blocks have emerged as an effective strategy for providing analgesia in hip fracture patients. Among these, the Fascia Iliaca Compartment Block (FICB) and the Femoral Nerve Block (FNB) are commonly used techniques. Both approaches aim to block sensory input from the femoral nerve and associated branches supplying the anterior thigh and hip region. Despite their widespread use, there is ongoing debate regarding their relative effectiveness, particularly in terms of pain control during positioning for spinal anesthesia.

FICB is a fascial plane block that targets the femoral nerve, lateral femoral cutaneous nerve, and occasionally the obturator nerve by depositing local anesthetic beneath the fascia iliaca. It is considered relatively easier to perform and may provide broader sensory coverage. In contrast, FNB is a more targeted nerve block that specifically anesthetizes the femoral nerve. While FNB may provide effective analgesia, its narrower coverage may limit its efficacy in certain clinical scenarios involving hip fractures.

This study is designed as a prospective, randomized, controlled clinical trial conducted at the Orthopedics Operation Theatre of Central Park Teaching Hospital, Lahore. A total of 80 patients scheduled for elective hip arthroplasty will be enrolled after meeting eligibility criteria. Participants will be randomly allocated into two equal groups using a lottery-based randomization method. Group A will receive Fascia Iliaca Compartment Block, while Group B will receive Femoral Nerve Block. All patients will subsequently undergo standard spinal anesthesia as part of routine surgical care.