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Para-Iliopsoas Block: Anatomical Rationale, Technique, and Contemporary Clinical Perspective

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Vol 6 | Issue 2 | July-December 2025 | Page 08-11 | Kirtika Yadav, Neel Kamal Mishra, Prem Raj Singh

DOI: https://doi.org/10.13107/ijra.2025.v06.i02.132

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted: 11-08-2025; Reviewed: 09-09-2025; Accepted: 21-11-2025; Published: 10-12-2025

Authors: Kirtika Yadav [1], Neel Kamal Mishra [1], Prem Raj Singh [1]

[1] Department of Anaesthesiology, King George’s Medical University, Lucknow, U.P., India.

Address of Correspondence

Dr. Prem Raj Singh,
Department of Anaesthesiology, King George’s Medical University, Lucknow, U.P. India.
E-mail: dr.p.rajsingh@gmail.com

Abstract

The para-iliopsoas (PIP) plane block is a novel regional anaesthesia technique developed to enhance analgesia for hip and proximal thigh surgeries. By targeting the fascial plane between the iliopsoas complex and fascia iliaca at the level of the anterior superior iliac spine, the PIP block facilitates deposition of local anaesthetic near the lumbosacral trunk. This approach aims to achieve reliable blockade of the femoral nerve, lateral femoral cutaneous nerve, and potentially the obturator nerve, thereby improving hip joint analgesia while minimizing quadriceps weakness. Ultrasound guidance enables precise needle placement and visualization of spread, with volumes of 20–30 ml required to overcome fascial resistance and promote longitudinal distribution. Clinical applications include total hip arthroplasty, hip arthroscopy, femoral neck fractures, and anterior thigh procedures, with reported benefits of reduced opioid consumption and improved patient positioning for neuraxial anaesthesia. However, limitations include variable obturator coverage, anatomical variability, and risks of peritoneal or vascular injury with deep needle advancement. Current evidence is limited to cadaveric, imaging, and small clinical series, underscoring the need for further validation. The PIP block holds promise as part of multimodal, opioid-sparing analgesia strategies in hip surgery.
Keywords: Regional anaesthesia, Fascial plane blocks, Hip surgery

References

1. Sharma SK, Sonawane K, Mistry T. A narrative review on fascial plane blocks–Part A: Anatomical foundations and mechanistic insights. Indian Journal of Anaesthesia. 2026 Jan 1;70(1):127-36. https://doi.org/10.4103/ija.ija_1553_25
2. Saini T, Aggarwal M, Singh U, Singh MR. Pericapsular nerve group (PENG) block versus supra-inguinal fascia iliaca (SIFI) block for functional outcome in patients undergoing hip surgeries–A randomised controlled study. Indian Journal of Anaesthesia. 2024 Dec 1;68(12):1043-8. https://doi.org/10.4103/ija.ija_838_24
3. Diwan S, Nair A, Gawai N, Shah D, Sancheti P. Circumpsoas block–an anterior myofascial plane block for lumbar plexus elements: case report. Brazilian Journal of Anesthesiology. 2023 Oct 23;73(5):689-94. https://doi.org/10.1016/j.bjane.2021.04.015
4. Hu J, Wang Q, Hu J, Gong C, Yang J. Analgesic efficacy of anterior iliopsoas muscle space block combined with local infiltration analgesia after total hip arthroplasty: a prospective, double-blind, placebo-controlled study. Anaesthesia Critical Care & Pain Medicine. 2023 Dec 1;42(6):101282. https://doi.org/10.1016/j.accpm.2023.101282
5. Ghimire A, Kalsotra S, Tobias JD, Veneziano G. Suprainguinal fascia iliaca compartment block in pediatric-aged patients: An educational focused review. Saudi Journal of Anaesthesia. 2025 Jan 1;19(1):65-76. https://doi.org/10.4103/sja.sja_467_24
6. Almeida CR. The novel proximal para-iliopsoas (PPIP) block for hip surgery: a technical report. Indian journal of anaesthesia. 2022 Dec 1;66(12):885-6.
https://doi.org/10.4103/ija.ija_735_22
7. Lastoria DA, Halicka Z, Liu KC, Bonsu EO, Reaveley M, Parry D. Fascia iliaca blocks: a cadaveric study comparing the suprainguinal approach to the loss of resistance technique. Cureus. 2023 Apr 28;15(4):e38243. https://doi.org/10.7759/cureus.38243
8. Vermeylen K, Desmet M, Leunen I, Soetens F, Neyrinck A, Carens D, Caerts B, Seynaeve P, Hadzic A, Van de Velde M. Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study. Regional Anesthesia & Pain Medicine. 2019 Apr 1;44(4):483-91. https://doi.org/10.1136/rapm-2018-100092
9. Jiang BW, Guo Y, Han YN, Bai YH, Chen X, Zhao KF, Liu YB, Wang CG. Iliopsoas plane block versus femoral nerve block for postoperative quality of recovery following hip arthroplasty: a randomized controlled trial. Scientific Reports. 2025 May 5;15(1):15723. https://doi.org/10.1038/s41598-025-00978-4
10. O’reilly N, Desmet M, Kearns R. Fascia iliaca compartment block. BJA education. 2019 Jun 1;19(6):191-7. https://doi.org/10.1016/j.bjae.2019.03.001
11. Yeoh SR, Chou Y, Chan SM, Hou JD, Lin JA. Pericapsular Nerve Group Block and Iliopsoas Plane Block: A Scoping Review of Quadriceps Weakness after Two Proclaimed Motor-Sparing Hip Blocks. Healthcare (Basel). 2022 Aug 18;10(8):1565. https://doi.org/10.3390/healthcare10081565

How to Cite this Article: Yadav K, Mishra NK, Singh PR. Para-Iliopsoas Block: Anatomical Rationale, Technique, and Contemporary Clinical Perspective. International Journal of Regional Anaesthesia. July-December 2025; 6(1): 08-11. DOI: https://doi.org/10.13107/ijra.2025.v06.i02.132

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Foot Drop after Hip Surgery – An Anaesthetic Perspective

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Vol 4 | Issue 1 | January-June 2023 | Page 31-32 | Vighnesh C S, Sheetal, Avneet Singh, Rajeev Kansay

DOI: https://doi.org/10.13107/ijra.2023.v04i01.073

Authors: Vighnesh C S [1], Sheetal [1], Avneet Singh [1], Rajeev Kansay [2]

[1] Department of Anaesthesia and Intensive Care, Government Medical College Hospital, Sector 32 Chandigarh, India.
[2] Department of Orthopaedics, Government Medical College Hospital, Sector 32 Chandigarh, India.

Address of Correspondence
Dr. Avneet Singh,
Assistant Professor, Department of Anaesthesia and Intensive Care, Government Medical College Hospital Sector 32, Chandigarh, India.
E-mail: avneetsinghch@gmail.com

To the Editor,

Foot drop is characterized by reduced muscle strength in the ankle dorsiflexors and inability to lift the forefoot. Foot drop occurring after an orthopedic procedure can occur due to various causes [1-5] (Figure 1). Epidural anaesthesia may sometimes attract undue attention in such a situation and presence of an epidural air pocket does not rule it out altogether as a cause. We describe an algorithmic approach to investigate the cause of foot drop after acetabular surgery performed under combined spinal-epidural anaesthesia.
A 35-year-old male, American Society of Anesthesiologists’-physical status (ASA-PS) II patient admitted with an alleged history of road-traffic accident and left acetabulum and 3rd–5th left rib fractures and hemothorax. He was initially managed for hypovolemic shock and mechanically ventilated for three days in the intensive care unit. The acetabular fracture was stabilized with tibial skeletal traction under local anesthesia. After hemodynamic stabilization, and an ICU stay duration of five days, he was planned for an acetabular fracture repair by posterior approach under combined spinal epidural anaesthesia. The preoperative evaluation and patient preparation were done as per institutional guidelines. Under aseptic precautions, combined spinal anaesthesia was applied in sitting position and midline approach at L3–L4 interspace. Epidural anaesthesia was given using 18 G Tuohy’s needle using the loss of resistance to 3 ml air at a depth of 5 cm and catheter fixed at 11 cm. The spinal anaesthesia was given with 26 G in the same lumbar space, with a clear flow of cerebrospinal fluid and 15 mg of 0.5% bupivacaine (hyperbaric) was given. The procedures were uneventful, and the patient did not report any paresthesia. The duration of surgery was 210 minutes, and 0.5% bupivacaine 5 mL was administered after 2 hours. The intraoperative period was uneventful. The postoperative analgesia was managed with epidural 0.125% bupivacaine (isobaric) with 2 μg/ml fentanyl infusion at 0.05–0.1 ml/kg/hour. On the second postoperative day, on initiating passive limb physiotherapy, the patient complained of difficulty in upward movement of ankle joint of operated limb. The clinical examination and investigations are depicted in Figure 2. A non-contrast computed tomography of the spine showed air pockets in the lumbar epidural space without hematoma (Figure 3). Initially, the epidural air pocket was considered the cause. However, this was unlikely due to the unilateral and singular peripheral nerve involvement. The diagnosis of left deep peroneal nerve injury that could have occurred due to tibial pin was made. He was initiated on limb physiotherapy and foot drop splint was applied. He was discharged with tablet diclofenac 50 mg 8th hourly and vitamin B12. On follow-up, 7 days after discharge with good physiotherapy and regular medications the patient had regained full power of dorsi-flexion.

References

[1] Carolus AE, Becker M, Cuny J, et al. The Interdisciplinary Management of Foot Drop. Dtsch Ärztebl Int. 2019;116: 347.
[2] Issack PS, Helfet DL. Sciatic Nerve Injury Associated with Acetabular Fractures. HSS J. 2009;5: 12.
[3] Giannoudis PV, Da Costa AA, Raman R, et al. Double-crush syndrome after acetabular fractures. J Bone Joint Surg Br. 2005;87-B: 401–7.
[4] Liporace FA, Yoon RS, Kesani AK. Transient common peroneal nerve palsy following skeletal tibial traction in a morbidly obese patient – case report of a preventable complication. Patient Saf Surg. 2012;6:4.
[5] Ng J, Marson BA, Broodryk A. Foot drop following closed reduction of a total hip replacement. BMJ Case Rep. 2016;2016: bcr2016215010.

How to Cite this Article: Vighnesh CS, Sheetal, Singh A, Kansay R | Foot Drop after Hip Surgery – An Anaesthetic Perspective | International Journal of Regional Anaesthesia | January-June 2023; 4(1): 31-32 | DOI: https://doi.org/10.13107/ijra.2023.v04i01.073

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