Efficacy and safety of combined supra-inguinal fascia iliaca compartment block and sacral plexus block versus spinal anesthesia in elderly patients undergoing hip fracture surgery: a prospective randomized controlled trial.

OBJECTIVE

This study aimed to evaluate the efficacy and safety of ultrasound-guided supra-inguinal fascia iliaca compartment block (FICB) combined with sacral plexus block (SPB) compared with spinal anesthesia (SA) in elderly patients undergoing hip fracture surgery.

METHODS

Ninety-eight elderly patients scheduled for hip fracture surgery were enrolled and randomly assigned to two groups: the FICB + SPB group (n = 49, ultrasound-guided supra-inguinal FICB combined with SPB), and the SA group (n = 49, spinal anesthesia). The primary outcome was postoperative pain intensity assessed using visual analog scale (VAS) scores at rest and during passive movement at 3, 6, 12, 18, 24, and 48 h postoperatively. Secondary outcomes included intraoperative hemodynamic parameters, sufentanil consumption, and rescue analgesic use. Anesthesia-related adverse events were also recorded.

RESULTS

VAS scores at rest and during movement were significantly lower at 3, 6, 12, and 18 h postoperatively in the FICB + SPB group (P < 0.05). Moreover, FICB + SPB group had lower sufentanil consumption and a lower proportion of patients requiring rescue analgesia (P < 0.05). The FICB + SPB group exhibited significantly higher blood pressure at skin incision and less intraoperative heart rate variability (P < 0.05). The incidence of nausea, vomiting, hypotension, and constipation was significantly lower in the FICB + SPB group compared to the SA group (P < 0.05).

CONCLUSION

Ultrasound-guided supra-inguinal FICB combined with SPB provides superior analgesia with fewer adverse events than spinal anesthesia, representing a safe and effective anesthetic alternative for high-risk elderly patients undergoing hip fracture surgery.

TRIAL REGISTRATION: The trial was retrospectively registered with the ISRCTN registry (ISRCTN16644322, registration date: 08/12/2025; https://www.isrctn.com/search?q=ISRCTN16644322 ).