Femoral Rami Obturator Nerve Trunk (FRONT) Block in Intramedullary Nail Surgery . (FRONT block)

The study propose that using femoral rami obturator nerve trunk(FRONT) block may help postoperative analgesia in nail femur surgeries. The technique is relatively new, introducing one needle to target two nerve blocks in the same entry point. The block spare motor fibers of femoral nerve so it may help both early mobilization and effective analgesia, which in turn enhance early recovery and better outcomes.

Study Overview

• Status: Recruiting
• Conditions: Anterior Hip Analgesia
• Intervention / Treatment: Procedure: Femoral rami obturator nerve trunk (FRONT) block; Drug: Multimodal systemic analgesia

Detailed Description

Post operative pain levels after hip fracture are high during ambulation and may worsen outcome after hip fracture. Regional anesthesia has shown to facilitate rehabilitation in orthopedics procedures. Many of these regional anesthesia techniques ,such as femoral nerve, lumber plexus, peri capsular nerve group(PENG), fascia iliaca blocks have gained attention for their opioid and some times for motor sparing potential, as well as the ability to provide targeted analgesia for anterior hip joint. Nevertheless the anterior hip joint coverage needs the constant contribution of femoral and obturator nerves to provide adequate pain relieve. In this study patients will receive preoperative femoral rami obturator nerve trunk(FRONT) block , a novel regional anesthesia technique described by Jessen et al., as a promising solution to the long-standing challenge of anesthetizing both the femoral and obturator nerve branches in anterior hip joint for postoperative pain control, addressing a more comprehensive coverage of anterior hip innervation.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Zeinab M Sayed, MD; Phone Number: +02 01009071365; Email: zeinab5aton@gmail.com

Study Locations

• Egypt
  • Qena Governorate
    • Qina, Qena Governorate, Egypt, 83511
      • Recruiting
      • Qena University
      • Contact: ZAINAB MOSTAFA; Phone Number: 002- 0100-9071365; Email: zeinab5aton@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• the elderly age≥60 years
• American Society of Anesthesiologists (ASA) classification 1-2
• patients who undergoing surgery for intramedullary nail surgery.

Exclusion Criteria:

• patient refused to participate and consent
• patients with a history of mild cognitive impairment (MCI), dementia, and delirium
• patients with known preoperative infections (pulmonary infection, urinary infection, and sepsis).
• coagulopathy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: FRONT Block; Participants (n=42) will receive Ultrasound-guided FRONT block. n=42 patients. Powered at 90% to detect 1-point NRS superiority (SD 1.8, alpha 0.05).	Procedure: Femoral rami obturator nerve trunk (FRONT) block; ultrasound-guided FRONT block will be performed at the infrainguinal level, targeting the iliopsoas plane. Using the same needle approach, the subpectineal compartment will be also accessed . We will use ultrasound and electrical nerve stimulation guidance (0.4 mA, 0.1 ms, without eliciting a motor response) to avoid direct involvement of the femoral nerve. A total of 40 mL (20 mL for the iliopsoas plane and 20 mL for the subpectineal compartment) of 0.125% plain levobupivacaine will be administered.
Active Comparator: Conventional Analgesia; Participants (n=42) patients will be assigned to intervention multimodal systemic analgesia. n=42 patients. Powered at 90% to detect 1-point NRS superiority (SD 1.8, alpha 0.05).	Drug: Multimodal systemic analgesia; Standard postoperative protocol: IV nalbuphine (6 mg bolus PRN when NRS>4 ); IV paracetamol 1g every 6 hours; IV ketorolac 30 mg every 8 hours PRN (NRS >4)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative analgesia	Pain level will be assessed after spinal anesthesia is resolved using rest/dynamic numeric rating scale (NRS) with patients rating their pain on a scale from 0 to 10. On this scale, 0 means "no pain" and 10 means "the worst pain imaginable"	Patients will be followed for 36 hours postspinal and assessed for pain, at 2, 4, 6, 12, 18, 24, 36 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Opioid consumption	First analgesic request time and total opioid consumption will be recorded	When 36 hours postoperatively has passed.
Motor function	Motor function will be assessed using Modified Bromage scale after spinal anesthesia has been resolved, where score 0 means full movement, and 4 means complete motor loss.	Patients will be followed for 36 hours postoperatively and assessed for motor function at 2, 4, 6, 12, 18, 24, 36 hours.
Complication	any complication either surgical or side effects will be recorded (vomiting, allergy, urinary retention, etc.)	Patients will be followed for 36 hours postoperatively and assessed for presence of any complications or side effects at 2, 4, 6, 12, 18, 24, 36 hours

Collaborators and Investigators

• Sponsor: South Valley University
• Investigators: Study Director: Zeinab M Sayed, MD, Qena University

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2025
• Primary Completion (Estimated): May 1, 2026
• Study Completion (Estimated): June 1, 2026

Study Registration Dates

• First Submitted: November 25, 2025
• First Submitted That Met QC Criteria: November 25, 2025
• First Posted (Actual): December 8, 2025

Study Record Updates

• Last Update Posted (Actual): February 19, 2026
• Last Update Submitted That Met QC Criteria: February 17, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System and Oral Physiological Phenomena; Dentistry; Dental Physiological Phenomena; Dental Occlusion
• Other Study ID Numbers: ِAIP029-4

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No