Related Experiment Video
Updated: May 24, 2026
04:19
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
A Problem-Based Approach to Hip Fracture Surgery in Frail Patients: Combining Sacral ESP and Quadro-iliac Plane
Francesco Marrone1, Tommaso Sorrentino2, Pierfrancesco Fusco3
1From the Department of Anesthesia and Intensive Care, Santo Spirito Hospital, Rome, Italy.
A&A Practice
|May 22, 2026
Summary
Elderly hip fracture patients can undergo surgery with combined sacral erector spinae plane (ESP) and Quadro-Iliac Plane (QIP) blocks. This anesthesia technique provided excellent pain relief, minimizing the need for additional analgesics post-operatively.
Area of Science:
- Anesthesiology
- Geriatric Medicine
- Orthopedic Surgery
Background:
- Hip fractures are common in the elderly, posing significant morbidity and mortality risks.
- Anesthetic management for hip fractures can be complex due to patient comorbidities and antiplatelet/anticoagulant use, often precluding general or neuraxial anesthesia.
- Alternative anesthetic techniques are needed for safe and effective hip fracture repair in this vulnerable population.
Purpose of the Study:
- To describe a novel anesthetic approach for hip fracture fixation in elderly patients.
- To evaluate the efficacy and safety of a combined sacral erector spinae plane (ESP) block and Quadro-Iliac Plane (QIP) block with dexmedetomidine sedation.
- To assess the postoperative pain control achieved with this combined regional anesthesia technique.
Main Methods:
- Two elderly patients with hip fractures requiring surgical fixation were included.
- Anesthesia was achieved using a combination of sacral erector spinae plane (ESP) block and Quadro-Iliac Plane (QIP) block.
- Patients received dexmedetomidine sedation, maintaining spontaneous ventilation throughout the procedure.
Main Results:
- Both patients experienced effective intraoperative anesthesia and analgesia.
- Postoperative pain was minimal to none for several hours after surgery in both cases.
- Paracetamol was the only additional analgesic required, administered 12 and 18 hours postoperatively.
Conclusions:
- The combination of sacral ESP block and QIP block offers a viable and effective anesthetic option for hip fracture fixation in elderly patients.
- This technique provides excellent postoperative pain relief, potentially reducing opioid consumption and related side effects.
- Dexmedetomidine sedation with spontaneous ventilation is compatible with this regional anesthesia approach, offering a safe alternative when neuraxial or general anesthesia is contraindicated.
