Analgesic Efficacy of Continuous S-ESP vs Continuous FICB After Hip Arthroplasty (SESP-HIP)

Comparison of the Analgesic Efficacy of Continuous Sacral Erector Spinae Plane Block (S-ESP) and Continuous Fascia Iliaca Compartment Block (FICB) After Hip Replacement Surgery: A Randomized Controlled Trial

The primary objective of this prospective, randomized, double-blind controlled trial is to compare the postoperative analgesic efficacy of continuous Sacral Erector Spinae Plane (S-ESP) block versus continuous Fascia Iliaca Compartment Block (FICB) in adult patients undergoing elective hip replacement surgery.

The investigators hypothesize that the continuous S-ESP block will provide non-inferior or superior pain relief compared to continuous FICB, while potentially reducing the incidence of motor block and facilitating earlier postoperative mobilization. Participants will be randomly assigned to receive either an S-ESP or FICB catheter for continuous local anesthetic infusion over 48 hours postoperatively. Postoperative pain scores, opioid consumption, and functional recovery will be systematically evaluated.

Study Overview

• Status: Active, not recruiting
• Conditions: Arthroplasty, Replacement, Hip; Pain, Postoperative; Anesthesia, Regional
• Intervention / Treatment: Procedure: Continuous Sacral Erector Spinae Plane Block; Procedure: Continuous Fascia Iliaca Compartment Block

Detailed Description

Effective postoperative pain management is crucial for early rehabilitation, patient satisfaction, and enhanced recovery after hip replacement surgery. While the continuous Fascia Iliaca Compartment Block (FICB) is a well-established and widely used regional anesthesia technique for hip surgery, it is frequently associated with quadriceps weakness, which can significantly delay early ambulation and physical therapy.

The continuous Sacral Erector Spinae Plane (S-ESP) block is a relatively novel, ultrasound-guided fascial plane block that targets the lumbar and sacral plexus branches. Recent literature suggests it offers profound sensory blockade with relative motor sparing, making it a highly attractive alternative for lower extremity surgeries.

In this study, eligible patients scheduled for elective unilateral hip replacement surgery at Bach Mai Hospital will be randomly allocated into two parallel arms: the S-ESP group and the FICB group. Under ultrasound guidance, a catheter will be inserted into the respective fascial plane (sacral erector spinae plane or fascia iliaca compartment). A continuous infusion of local anesthetic will be administered via the catheter for 48 hours postoperatively.

Both groups will receive a standardized multimodal systemic analgesia protocol. Rescue analgesia (intravenous opioids) will be provided on demand. A blinded outcome assessor will meticulously record static and dynamic pain scores, cumulative opioid consumption, the degree of motor blockade, time to first ambulation, and any procedure-related adverse events. The findings of this study will help determine if continuous S-ESP is a more optimal regional anesthesia strategy compared to the traditional continuous FICB for postoperative pain control in hip arthroplasty.

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

Contacts and Locations

Study Locations

• Vietnam
  • Hanoi
    • Hanoi, Hanoi, Vietnam, 100000
      • Bach Mai hospital

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Adult patients aged 18 to 100 years.
• Scheduled for elective unilateral hip replacement surgery.
• American Society of Anesthesiologists (ASA) physical status I, II, or III.
• Ability to communicate effectively and understand the pain scale (VAS).
• Provided written informed consent.

Exclusion Criteria:

• Patient refusal to participate in the study.
• Contraindications to regional anesthesia (e.g., coagulopathy, therapeutic anticoagulation, or local infection at the injection site).
• Known allergy or hypersensitivity to local anesthetics (e.g., Ropivacaine, Bupivacaine).

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: Continuous S-ESP; Patients in this arm will receive an ultrasound-guided continuous Sacral Erector Spinae Plane (S-ESP) block for postoperative analgesia following hip replacement surgery.	Procedure: Continuous Sacral Erector Spinae Plane Block; Under ultrasound guidance, a catheter is inserted into the sacral erector spinae plane. A continuous infusion of local anesthetic (e.g., 0.2% Ropivacaine) is administered via the catheter for 72 hours postoperatively.; Other Names: Continuous Sacral ESP Block; Continuous Sacral ESPB
Active Comparator: Continuous FICB; Patients in this arm will receive an ultrasound-guided continuous Fascia Iliaca Compartment Block (FICB) for postoperative analgesia following hip replacement surgery.	Procedure: Continuous Fascia Iliaca Compartment Block; Under ultrasound guidance, a catheter is inserted deep to the fascia iliaca. A continuous infusion of local anesthetic (e.g., 0.2% Ropivacaine) is administered via the catheter for 72 hours postoperatively.; Other Names: Continuous Fascia Iliaca Block; Continuous FICB; Continuous Fascia Iliaca Compartment Block (CFICB)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cumulative Opioid Consumption at 24 Hours Postoperatively	The total amount of rescue opioid analgesics administered to the patient, converted to intravenous morphine milligram equivalents (MME). A higher value represents a worse outcome (greater need for rescue analgesia).	During the first 24,48,72 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative Pain Intensity at Rest	Pain intensity at rest assessed using the Visual Analog Scale (VAS). The VAS is an 11-point scale ranging from 0 to 10, where 0 indicates "no pain" and 10 indicates "the worst imaginable pain." A higher score indicates greater pain severity.	At 2, 6, 12, 24, 48, 36 and 72 hours postoperatively.
Postoperative Pain Intensity During Movement	Pain intensity during passive or active movement (e.g., hip flexion) assessed using the Visual Analog Scale (VAS). The VAS is an 11-point scale ranging from 0 to 10, where 0 indicates "no pain" and 10 indicates "the worst imaginable pain." A higher score indicates greater pain severity.	At 2, 6, 12, 24, 48, 36 and 72 hours postoperatively

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to First Postoperative Mobilization	The duration from the completion of surgery to the patient's first successful achievement of three distinct mobilization milestones: (1) sitting up in bed or chair, (2) standing independently or with minimal assistance, and (3) taking the first steps/walking. Time is recorded in hours. A shorter duration indicates faster functional recovery and earlier ambulation.	Up to 72 hours postoperatively.

Collaborators and Investigators

• Sponsor: Bach Mai Hospital

Study record dates

Study Major Dates

• Study Start (Actual): September 25, 2025
• Primary Completion (Estimated): May 30, 2026
• Study Completion (Estimated): June 30, 2026

Study Registration Dates

• First Submitted: April 1, 2026
• First Submitted That Met QC Criteria: April 1, 2026
• First Posted (Actual): April 8, 2026

Study Record Updates

• Last Update Posted (Actual): April 8, 2026
• Last Update Submitted That Met QC Criteria: April 1, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Regional Anesthesia; FICB; Fascia Iliaca Compartment Block; Sacral Erector Spinae Plane Block; S-ESP; Continuous Analgesia
• Additional Relevant MeSH Terms: Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain
• Other Study ID Numbers: SESP-FICB-HIP-RCT-2026; BM_2025_33 (Other Identifier: Institutional Review Board of Bach Mai Hospital)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Public sharing of IPD is not planned due to patient confidentiality regulations in Vietnam. However, completely de-identified data underlying the results reported in this study may be made available to qualified researchers upon a reasonable and methodologically sound request, strictly subject to approval by the Principal Investigator and the Institutional Review Board.

Drug and device information, study documents

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