Ultrasound-guided femoral rami and obturator nerve trunk (FRONT) block for total hip arthroplasty: an analgesic regimen for anterior hip.

With the deepening of global population aging, the incidence of hip fractures in the elderly has been increasing year by year. Elderly patients with hip fractures often experience severe resting and movement-related pain, and effective perioperative pain management is critical to shortening hospital length of stay, reducing medical costs, and lowering the risk of postoperative complications and all-cause mortality. However, elderly patients are typically frail with multiple comorbidities, which is associated with a significantly higher incidence of adverse events related to non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, greatly limiting the clinical application of these systemic analgesics.Regional anesthesia techniques, including femoral nerve block, lumbar plexus block, pericapsular nerve group (PENG) block, and fascia iliaca compartment block (FICB), have been widely explored for hip fracture analgesia, given their advantages of reducing opioid consumption, providing targeted anterior hip analgesia, and potential to preserve motor function. However, these techniques still have inherent limitations: most cannot achieve reliable and consistent block of the obturator nerve, while femoral nerve block and lumbar plexus block are prone to impair lower limb motor function. Recently, Jessen et al. introduced a novel ultrasound-guided regional anesthesia technique, the femoral rami and obturator nerve trunk (FRONT) block, which is designed to overcome the above limitations by fully covering the dual sensory innervation of the anterior hip capsule. This descriptive case series study included elderly patients undergoing total hip arthroplasty (THA) for hip fracture, and aimed to verify the safety and efficacy of this novel ultrasound-guided regional analgesic technique in perioperative anterior hip analgesia.