Comparison of effectiveness and safety between spinal anesthesia and USG guided ESP block from l4 vertebrae level in proximal femur and hip surgery

Objective: We aimed to compare Lumbar Erector Spina Plane Block under moderate sedation with spinal anesthesia in terms of effective and safe surgical anesthesia and postoperative analgesia in hip fractures encountered in the elderly patient population with many comorbidities. Material and Methots: We picked 68 patients with ASA score between I-III who will be operated for hip and proximal femur fractures. Patients divided into two equal groups. ESP Block at the level of 4th lumbar vertebrae with guidance of ultrasound applied 34 patients. Two patients excluded from our study because of unsuccessful block. Spinal anesthesia applied between L4-L5 vertebrae with 10mg Bupivacaine to 34 patients. Patients demographic datas and preoperative vital signs recorded. We used Anesthesia Success Scoring for both groups. Intraoperative vital signs, additional analgesic requirement and postoperative first analgesic administration times were recorded. Findings: There isn't any statisticaly significant difference in demographic datas between two groups (p<0,05). There isn't any statisticaly significant difference in Anesthesia Success Scoring between two groups. Intraoperative data of hypotension shows that incidence of hypotension was statisticaly significantly low in ESP applied patients. First analgesic administration time was 2,24±0,94 hours at Spinal Anesthesia and 11,17±1,40 hours at ESP applied group. In ESP applied patients postoperative analgesia time was istatistically significantly high compared to Spinal anesthesia (p=0,001). Result: It has been shown that the Lumbar Erector Spina Plan block under moderate sedation creates sufficient anesthesia that can be an alternative to spinal anesthesia in hip operations, and has a low incidence of hypotension and long lasting post-operative analgesia time. Keywords: Hip fracture, Erector Spinae Plane Block, Spinal Anesthesia, Post-operative analgesia, Hypotension