Preoperative Supra-inguinal Fascia Iliaca Block for Positioning Analgesia in Hip Fracture Patients Undergoing Spinal Anesthesia

Hip fractures are an increasingly grave concern with an increase in geriatric global population. It has been the principal cause of morbidity in patients aged 65 \& older. The number of hip fractures is expected to rise to 4.5 million globally by the year 2050, which will pose a huge burden on the medical \& social expenditures.

Hip fractures in elderly patients prompt early surgical intervention. Spinal anaesthesia is commonly administered for hip fracture surgeries due to its advantages of minimized operative time, lesser bleeding and fewer complications. The management of these patients provides the anesthetist a great ordeal of managing a geriatric case with multiple comorbid conditions. A significant concern is the patient positioning for regional anaesthesia in a patient with restricted mobility, along with severe, excruciating pain. NSAIDS or opioids provide inadequate analgesia in addition to causing unwanted side effects and fail to reduce discomfort since it is difficult for patients with hip fractures to remain in a sitting or lateral position required for spinal anaesthesia. Effective early pain management, beginning in the Emergency department is pivotal to improving patient comfort, thereby mitigating physiological stress responses and facilitating a multimodal analgesic regimen.

The ultrasound-guided suprainguinal fascia iliaca compartment block (SIFI block) is a regional anesthesia technique that targets the femoral, lateral femoral cutaneous, and obturator nerves, providing profound analgesia for hip fractures.

Limited research exists on ultrasound-guided emergency SIFI blocks for hip fracture patients, with inconclusive data about functional outcomes such as VAS scores in tertiary care hospital patients. The foundation of this research is to investigate whether including ultrasound-guided SIFI block through emergency protocols for hip fracture patients will create measurable improvements in patient positioning and extend analgesic duration while improving both patient recovery and satisfaction.