الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Total hip arthroplasty is a common surgical procedure associated with significant postoperative pain. Adequate analgesia with minimal side effects allows for early postoperative mobility, optimal functional recovery, and decreased postoperative morbidity. It has been recommended to use two or more analgesic modalities with different mechanisms of action that will provide analgesia while limiting side effects and adverse events to decrease pain in total joint arthroplasty. Peripheral nerve blocks (PNB) are essential for perioperative multimodal analgesia, providing site-specific, rapid-onset analgesia and attracting increasing attention. The fascia iliaca compartment block (FICB) remains a popular regional anesthetic technique for surgical procedures involving the hip joint and femur. The FICB may be considered as an anterior approach to the lumbar plexus where local anesthetic (LA) is injected proximally beneath the fascia iliaca to block the femoral nerve (FN), obturator nerve (ON) and lateral cutaneous nerve of the thigh (LCNT) simultaneously. Ultrasound-guided erector spinae plane (ESP) block is a relatively recent regional anesthetic technique. Local anesthetic (LA) is injected between the erector spinae muscle and the vertebra’s transverse process, leading to the spread of LA cephalad, caudally, and through the paravertebral space. The aim of this study was to compare the analgesic efficacy of ultrasound-guided L-ESPB versus FICB in patients scheduled for total hip arthroplasty, as well as the total postoperative rescue analgesic requirements in the first 24 hours, the time of first rescue analgesic, hemodynamic measurements, and the incidence of any block-related side effects. The Numerical rating scale (NRS) was used to assess pain intensity. This study was carried out on 75 Adult patients aged 30-75 years of both sexes, ASA physical status I-III, scheduled for unilateral total hip replacement surgery under spinal anesthesia. By randomly selecting envelopes in the operating room, these patients were assigned to one of three groups, each with 25 patients. • Control group: Patients who received spinal anesthesia alone. • L-ESPB group: Patients who received spinal anesthesia and then ipsilateral L-ESPB (30 ml of bupivacaine 0.25%) at the level of the lumbar region in the operating room after the end of the surgery. • FICB group: Patients who received spinal anesthesia and then ipsilateral suprainguinal FICB (30 ml of bupivacaine 0.25%) in the operating room after the end of the surgery. The results of the current study revealed that the use of L-ESPB and FICB in patients undergoing total hip arthroplasty, compared to patients in the control group, was associated with prolonged duration of analgesia as shown by lower NRS, as well as with reduced rescue opioid consumption up to 24 hours postoperatively. Moreover, the results of the L-ESPB for hip analgesia were comparable to the FICB in all measured parameters. Furthermore, no block-related side effects were detected in our study.