Lumbosacral erector spinae plane block for hip fractures in the elderly: a two-center case series and descriptive analysis

Abstract

Hip fractures in frail elderly patients pose significant anesthetic challenges due to comorbidities and contraindications to neuraxial techniques. This two-center retrospective case series evaluated the feasibility of combined lumbosacral erector spinae plane (ESP) block with femoral or pericapsular nerve group (PENG) block as the anesthetic approach for hip fracture surgery in 14 high-risk patients with American Society of Anesthesiologist – Physical Status (ASA-PS) III-IV, aged 78-102 years. All procedures were ultrasound-guided and performed under light sedation by experienced anesthesiologist; preoperative, intraoperative, end-of-surgery, 12-hour, and 24-hour postoperative pain were recorded using the Numeric Rating Scale (NRS). Preoperative pain (median NRS 5.5) decreased markedly after anesthesia (median intraoperative NRS 2.0), with all patients maintaining NRS<4 intra- and postoperatively. No conversion to general or neuraxial anesthesia was required, and no complications occurred. Pain control remained stable up to 24 hours postoperatively. These findings suggest that the lumbosacral ESP block combined with femoral or PENG block could offer a safe and effective alternative for anesthesia and analgesia in elderly patients undergoing hip fracture repair.