Abstract
OBJECTIVES: In this study, we evaluated perioperative pain management using the Analgesia Nociception Index (ANI) monitoring in high-risk ASA III-IV patients scheduled for hip surgery. Specifically, we examined the lumbar plexus (LP), sacral plexus (SP), and supra-inguinal fascia iliaca compartment blocks (SIFIB), as well as combinations of SP blocks. METHODS: In this prospective observational study, we included 74 patients who were assigned to one of two groups: Group L, which received LP and SP blocks, and Group F, which received SIFIB and SP blocks. Surgery was performed after confirming the sensory block with the pinprick test and applying the sedation protocol. Sedation levels were evaluated using the BIS monitor whereas analgesic requirements were assessed using the ANI monitor. Demographic data, including age, sex, ASA score, SpO(2), heart rate (HR), mean arterial pressure (MAP), duration of sensorimotor block, type and duration of surgery, time to first analgesic use, and total analgesic consumption, were recorded. Visual analog scale (VAS) scores at 0, 6, 12, and 24 h additional analgesic requirements, and satisfaction ratings from patients and surgeons were also evaluated. RESULTS: Compared to Group F, Group L presented significantly greater ANI values at 30, 60, 90 min intraoperatively, as well as at 6 and 12 h postoperatively. The VAS scores were consistently higher in Group F than in Group L at all measurement times. CONCLUSION: Group L provided better analgesia, required fewer sedatives during surgery, and had greater satisfaction among patients and surgeons. A negative correlation was found between the VAS score and ANI for assessing patient pain.