Femoral Rami Obturator Nerve Trunk (FRONT) Block in Intramedullary Nail Surgery .

NCT07268911 | Completed

• 1 other identifier: ِAIP029-4
• Study Type: interventional
• Target: 84
• Locations: 1 country
• Sites: 1

Brief Summary

The study propose that using femoral rami obturator nerve trunk(FRONT) block may help postoperative analgesia in nail femur surgeries. The technique is relatively new, introducing one needle to target two nerve blocks in the same entry point. The block spare motor fibers of femoral nerve so it may help both early mobilization and effective analgesia, which in turn enhance early recovery and better outcomes.

Conditions

Anterior Hip Analgesia

Outcome Measures

Primary Outcomes (1)

• Time to first postoperative analgesic request

  Description: Time in hours when the first patient request for rescue analgesia (IV nalbuphine 6 mg iv bolus)

  [Time Frame: up to 36 hours postoperatively]

Secondary Outcomes (5)

• Opioid consumption

  When 36 hours postoperatively has passed.

• Complication

  Patients will be followed for 36 hours postoperatively and assessed for presence of any complications or side effects at 2, 4, 6, 12, 18, 24, 36 hours

• Numeric Rating Scale (NRS)

  Time Frame: 2, 4, 6, 12, 18, 24, 36 hours postoperatively]

• Manual Muscle Testing (MRC scale)

  Time Frame: 2, 4, 6, 12, 18, 24, 36 hours postoperatively

• Straight Leg Raise (SLR) test

  [Time Frame: 2, 4, 6, 12, 18, 24, 36 hours postoperatively]

Study Arms (2)

FRONT Block

EXPERIMENTAL

FRONT Block: Patients received an ultrasound-guided femoral rami and obturator nerve trunk (FRONT) block, performed in the operating room prior to spinal anesthesia with the patient supine. Using an in-plane technique with a 22-gauge echogenic needle through a single entry point, 20 mL of 0.125% plain levobupivacaine was deposited in the iliopsoas plane and 20 mL in the subpectineal compartment. Electrical nerve stimulation (0.4 mA, 0.1 ms pulse duration) was used to confirm needle placement and exclude direct femoral motor nerve involvement prior to injection. Sensory block was confirmed via pinprick before proceeding to spinal anesthesia. All patients, including the FRONT group, received the same standardized multimodal systemic analgesic regimen (paracetamol 1g/6h and ketorolac 30 mg /8h routinely plus nalbuphine 6 mg IV bolus as rescue analgesia when needed for NRS ≥ 4)

Procedure: Femoral rami obturator nerve trunk (FRONT) block

Control group

SHAM COMPARATOR

Sham Control: Patients underwent an identical ultrasound-guided needle insertion procedure at the same anatomical sites (iliopsoas plane and subpectineal compartment) with injection of an equivalent volume of placebo drug in the form of normal salin. All patients, including the sham group, received the same standardized multimodal systemic analgesic regimen (paracetamol 1g/6h and ketorolac 30 mg /8h routinely plus nalbuphine 6 mg IV bolus as rescue analgesia when needed for NRS ≥ 4)

Procedure: Sham block

Interventions

Sham block PROCEDURE

Sham Control: Patients underwent an identical ultrasound-guided needle insertion procedure at the same anatomical sites and technique of FRONT block (iliopsoas plane and subpectineal compartment) with injection of an equivalent volume of placebo drug in the form of normal saline.

Control group

Femoral rami obturator nerve trunk (FRONT) block PROCEDURE

ultrasound-guided FRONT block will be performed at the infrainguinal level, targeting the iliopsoas plane. Using the same needle approach, the subpectineal compartment will be also accessed . We will use ultrasound and electrical nerve stimulation guidance (0.4 mA, 0.1 ms, without eliciting a motor response) to avoid direct involvement of the femoral nerve. A total of 40 mL (20 mL for the iliopsoas plane and 20 mL for the subpectineal compartment) of 0.125% plain levobupivacaine will be administered.

FRONT Block

Eligibility Criteria

• Age: 60 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• the elderly age≥60 years
• American Society of Anesthesiologists (ASA) classification 1-2
• patients who undergoing surgery for intramedullary nail surgery.

You may not qualify if:

• patient refused to participate and consent
• patients with a history of mild cognitive impairment (MCI), dementia, and delirium
• patients with known preoperative infections (pulmonary infection, urinary infection, and sepsis).
• coagulopathy

Sponsors & Collaborators

• South Valley University: lead

Study Sites (1)

Qena University

Qina, Qena Governorate, 83511, Egypt

Location

MeSH Terms

Interventions

Dental Occlusion

Intervention Hierarchy (Ancestors)

Dentistry; Dental Physiological Phenomena; Digestive System and Oral Physiological Phenomena

Study Officials

• Zeinab M Sayed, MD

  Qena University

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: lecturer in anesthesia, Intensive Care and Pain Management

Study Record Dates

• First Submitted: November 25, 2025
• First Posted: December 8, 2025
• Study Start: January 1, 2026
• Primary Completion: June 1, 2026
• Study Completion: June 1, 2026
• Last Updated: August 4, 2026

Record last verified: 2026-08

Data Sharing

• IPD Sharing: Will not share

Locations

EG (1)