Needle Nerve Contact in Ultrasound Guided Femoral Block

• Number of intraneural needle insertion in ultrasound-guided femoral block: out-of-plane versus in-plane approach [ Time Frame: 4 months ] [ Designated as safety issue: Yes ]
  The incidence of needle-nerve contact is higher with the out-of-plane approach (inserting the needle into the fascia at the midpoint over the femoral nerve)needle-nerve contact than with the in-plane approach (inserting the needle lateral to the femoral nerve).
  
  

• Number of Participants with femoral block success in ultrasound-guided femoral block: out-of-plane versus in-plane approach. [ Time Frame: 4 months ] [ Designated as safety issue: Yes ]
  The efficacy of the out-of-plane approach (inserting the needle into the fascia at the midpoint over the femoral nerve)needle-nerve contact and the in-plane approach (inserting the needle lateral to the femoral nerve).
  
  

Fourty-four patients with hip fracture (American Society of Anesthesiologists physical status 1-3) are being randomized to receive the femoral block with an out-of-plane (needle inserted at a 45°-60° angle 1 cm caudal to the midpoint of the ultrasound probe just above the femoral nerve) or an in-plane technique (needle inserted 0.5 cm from the side of the probe lateral to the femoral nerve). The data collected includes the depth of needle insertion at the endpoint before injection, response to nerve stimulation, distribution of the injected volume in relation to the nerve (anterior vs posterior, the latter indicating impalement), block efficacy at 20 minutes and 24 hours, and any signs of nerve injury).