Comparison of Lumbar Erector Spinae Plane Block and Spinal Anesthesia in Hip and Proximal Femur Surgery (L-ESP-HIP Stud)

Comparison of Efficacy and Safety Between Ultrasound-Guided L4 Level 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.

Study Overview

• Status: Completed
• Conditions: Femoral Neck Fractures; Hip Surgery
• Intervention / Treatment: Procedure: Ultrasound-Guided Lumbar Erector Spinae Plane Block (L4); Procedure: Spinal Anesthesia (L4-L5)

Detailed Description

Hip and proximal femur surgeries are frequently performed in elderly patients and require anesthetic techniques that provide sufficient surgical anesthesia while limiting the need for additional intraoperative opioid administration. In this patient population, selecting an appropriate anesthetic approach is particularly important due to age-related physiological changes and the presence of comorbidities.

This study was designed as a prospective, randomized, single-blind clinical trial comparing ultrasound-guided lumbar erector spinae plane (ESP) block performed at the L4 vertebral level with spinal anesthesia in patients undergoing hip and proximal femur surgery. After obtaining written informed consent, eligible adult patients were randomly assigned to one of the two anesthetic techniques using a computer-generated randomization sequence. Intraoperative assessments were performed by an investigator who was blinded to group allocation.

All patients received standardized premedication consisting of intravenous midazolam 2 mg and fentanyl 100 µg prior to the anesthetic procedure. In the spinal anesthesia group, spinal anesthesia was performed at the L4-L5 interspace according to institutional routine practice. In the ESP block group, an ultrasound-guided erector spinae plane block was performed at the L4 level using a total volume of 30 mL of local anesthetic solution, composed of 15 mL of 0.5% isobaric bupivacaine, 7.5 mL of 2% lidocaine, and 7.5 mL of normal saline.

Standard intraoperative monitoring, including electrocardiography, non-invasive blood pressure measurement, and peripheral oxygen saturation, was applied to all patients throughout the surgical procedure. The adequacy of anesthesia was evaluated intraoperatively based on clinical signs and the requirement for additional opioid administration. Intraoperative opioid use was recorded as present or absent and documented.

When inadequate anesthesia or analgesia was observed, rescue opioid analgesia was administered according to a standardized institutional protocol. Patients in whom adequate anesthesia could not be achieved with the assigned technique and who required conversion to general anesthesia were excluded from the final analysis.

The primary parameters evaluated in this study included the anesthetic technique applied (lumbar ESP block or spinal anesthesia), intraoperative opioid use and the time to first postoperative rescue analgesic administration. This study aims to provide clinical data on whether lumbar ESP block can be used as an effective and safe alternative to spinal anesthesia in hip and proximal femur surgery.

• Study Type: Interventional
• Enrollment (Actual): 66
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Gaziantep, Turkey (Türkiye)
    • Gaziantep University

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Age 18 to 80 years
• American Society of Anesthesiologists (ASA) physical status I, II, or III
• Patients diagnosed with hip fracture requiring surgical intervention
• Patients diagnosed with proximal femur fracture requiring surgical intervention

Exclusion Criteria:

• Known allergy to local anesthetic agents
• Patients younger than 18 years or older than 80 years
• American Society of Anesthesiologists (ASA) physical status IV or higher
• Lumbar skeletal deformity or history of previous lumbar spine surgery
• Contraindications to regional anesthesia (e.g., coagulopathy, infection at the injection site, severe hypovolemia, patient refusal)
• Pregnancy

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Lumbar ESP Block (L4, Ultrasound-Guided); Participants receive an ultrasound-guided lumbar erector spinae plane (ESP) block at the L4 level using a total of 30 mL local anesthetic solution (15 mL 0.5% isobaric bupivacaine + 7.5 mL 2% lidocaine + 7.5 mL 0.9% NaCl). Standard premedication is administered to all participants (midazolam 2 mg IV and fentanyl 100 µg IV). Inadequate anesthesia requiring conversion to general anesthesia is considered block failure and those participants are excluded from final analysis.	Procedure: Ultrasound-Guided Lumbar Erector Spinae Plane Block (L4); Ultrasound-guided lumbar erector spinae plane (ESP) block performed at the L4 level using a total of 30 mL local anesthetic solution (15 mL 0.5% isobaric bupivacaine + 7.5 mL 2% lidocaine + 7.5 mL 0.9% NaCl). All participants receive standardized premedication with midazolam 2 mg IV and fentanyl 100 µg IV prior to the procedure. Intraoperative opioid requirement/consumption and time to first postoperative rescue analgesic administration are recorded. Participants requiring conversion to general anesthesia due to inadequate anesthesia are considered block failures and are excluded from final analysis.
Active Comparator: Spinal Anesthesia (L4-L5); Participants receive spinal anesthesia at the L4-L5 interspace according to institutional routine practice (e.g., intrathecal bupivacaine). Standard premedication is administered to all participants (midazolam 2 mg IV and fentanyl 100 µg IV). Intraoperative opioid requirement/consumption and time to first postoperative rescue analgesic administration are recorded.	Procedure: Spinal Anesthesia (L4-L5); Spinal anesthesia performed at the L4-L5 interspace according to institutional routine practice. All participants receive standardized premedication with midazolam 2 mg IV and fentanyl 100 µg IV prior to the procedure. Intraoperative opioid requirement/consumption and time to first postoperative rescue analgesic administration are recorded.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to First Postoperative Rescue Analgesia	Time elapsed from the end of surgery until the first postoperative rescue analgesic is administered. Rescue analgesia is given according to the institutional protocol when clinically indicated.	From the end of surgery to the first administration of rescue analgesic (up to 24 hours)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intraoperative Opioid Requirement (Yes/No)	Whether additional intraoperative opioid was required for inadequate analgesia (recorded as yes/no) beyond standardized premedication.	During surgery (from start of surgery to end of surgery)
Incidence of intraoperative hypotension	>20% decrease from baseline mean arterial pressure	Intraoperative period

Collaborators and Investigators

• Sponsor: Gaziantep City Hospital

Publications and helpful links

General Publications

• Ahiskalioglu A, Tulgar S, Celik M, Ozer Z, Alici HA, Aydin ME. Lumbar Erector Spinae Plane Block as a Main Anesthetic Method for Hip Surgery in High Risk Elderly Patients: Initial Experience with a Magnetic Resonance Imaging. Eurasian J Med. 2020 Feb;52(1):16-20. doi: 10.5152/eurasianjmed.2020.19224.

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2022
• Primary Completion (Actual): September 1, 2022
• Study Completion (Actual): September 1, 2022

Study Registration Dates

• First Submitted: February 16, 2026
• First Submitted That Met QC Criteria: February 16, 2026
• First Posted (Actual): February 23, 2026

Study Record Updates

• Last Update Posted (Actual): April 15, 2026
• Last Update Submitted That Met QC Criteria: April 11, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Hip Fracture; Spinal Anesthesia; Erector Spinae Plane Block; Proximal Femur Fracture; Hip Surgery; Ultrasound-Guided Regional Anesthesia; Intraoperative Opioid Consumption; Lumbar ESP Block; Intraoperative Opioid Requirement; Rescue Analgesia Time; Single-Blind Randomized Trial
• Additional Relevant MeSH Terms: Wounds and Injuries; Leg Injuries; Fractures, Bone; Femoral Fractures; Hip Injuries; Hip Fractures; Femoral Neck Fractures; Proximal Femoral Fractures; Anesthesia and Analgesia; Anesthesia, Conduction; Anesthesia; Anesthesia, Spinal
• Other Study ID Numbers: 190

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