Comparison of Lumbar Erector Spinae Plane Block and Spinal Anesthesia in Hip and Proximal Femur Surgery

Hip and proximal femur surgeries are commonly performed in elderly patients and require anesthetic techniques that provide adequate surgical anesthesia while minimizing the need for additional opioid administration. Spinal anesthesia is widely used for these procedures; however, it may be associated with intraoperative opioid requirements and hemodynamic changes. The lumbar erector spinae plane (ESP) block is a regional anesthesia technique that may be used as an alternative anesthetic approach in hip and proximal femur surgery. This prospective, randomized, single-blind study compares ultrasound-guided lumbar erector spinae plane block performed at the L4 level with spinal anesthesia in patients undergoing hip and proximal femur surgery. A total of 68 adult patients with ASA physical status I-III were allocated to receive either lumbar ESP block or spinal anesthesia. All patients received standardized premedication consisting of intravenous midazolam 2 mg and fentanyl 100 µg. The study evaluated the applied anesthetic technique, intraoperative opioid use and the time to first postoperative rescue analgesic administration. Patients in whom adequate anesthesia could not be achieved with the assigned technique and required conversion to general anesthesia were excluded from the final analysis. The results of this study may help determine whether lumbar ESP block is a feasible and safe alternative to spinal anesthesia in hip and proximal femur surgeries.