Patients Scheduled for Elective Lower Extremity SurgeryNCT07594197
Parasacral Ischial Plane Block in Lower Extremity Surgery
A study testing Parasacral Ischial Plan Block and Sacral plexus block in people with Patients Scheduled for Elective Lower Extremity Surgery and Ages 18-80, run by Bursa Yuksek Ihtisas Training and Research Hospital at 1 site in Turkey (Türkiye).
Trial summary
The parasacral ischial plane block is a novel fascial plane approach targeting the sacral plexus. This technique is technically less challenging and eliminates the requirement for direct visualization of the sacral plexus. Read more about this study
- Who is it for?
- Ages 18 to 80 years
- Conditions the study is for
- Patients Scheduled for Elective Lower Extremity Surgery, Ages 18-80, ASA I-III
- What is being tested?
- Parasacral Ischial Plan Block and Sacral plexus block
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 1 May 2026to 1 May 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 80 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Ages 18-80
- ASA I-III
- Patients operated on under regional anesthesia
- Patients who provided written informed consent
- Patients scheduled for elective lower extremity surgery -
Who cannot join
- Patients with a history of allergy to local anesthetic drugs
- Patients with coagulation disorders
- Patients with BMI > 40 kg/m²
- Presence of infection at the block application site
- Chronic pain syndrome (chronic opioid use)
- Pregnant women
- Patients who cannot be communicated with
- Patients requiring emergency surgery -
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Turkey (Türkiye)1 site
Bursa High Specialization Training and Research Hospital
Bursa, Yildirim, 16300
About this study
Official title: Evaluation of Sensory and Motor Blockade of Ultrasound-Guided Parasacral Ischial Plane Block in Lower Extremity Surgery
The parasacral ischial plane block is a novel fascial plane approach targeting the sacral plexus. This technique is technically less challenging and eliminates the requirement for direct visualization of the sacral plexus. The aim of this prospective observational study is to evaluate the efficacy of the conventional sacral plexus block versus the parasacral ischial plane block in patients undergoing lower extremity surgery.
Read the detailed description
Sympatholysis resulting from central neuraxial block or general anesthesia in lower extremity surgeries may lead to adverse hemodynamic changes and increased perioperative mortality, particularly in high-risk patients. In such patients, lower extremity procedures can be successfully performed solely under sciatic and femoral nerve blocks. Depending on the surgical indication, the sciatic nerve block may be utilized alone or in combination with a lumbar plexus or femoral nerve block.A novel ultrasound-guided (USG) fascial plane approach targeting the sacral plexus, termed the Parasacral Ischial Plane (PIP) block, has been successfully investigated in a limited number of patients. The sacral plexus is located within a fascial plane formed by the pelvic fascia anteriorly, the sacrum medially, the piriformis and gluteus maximus muscles posteriorly, and the ischium bone laterally. The piriformis muscle has no attachment to the ischium; instead, it attaches laterally to the greater trochanter. A fascial plane exists between the piriformis muscle and the ischium, which extends directly to the sacral plexus.
Venkataraju et al. stated that during the demonstration of the PIP block, the needle should be directed and positioned toward the posteromedial surface of the ischium. Following bony contact, the injectate was administered, and its spread was observed beneath the piriformis muscle toward the sacral plexus (SP). This method is considered to be technically more straightforward and carries a lower risk profile.
- Conditions
- Patients Scheduled for Elective Lower Extremity Surgery, Ages 18-80, ASA I-III, Patients Operated on Under Regional Anesthesia, Patients Who Provided Written Informed Consent
- Being tested
- Parasacral Ischial Plan Block, Sacral plexus block
- Keywords
- Lumbosacral Plexus, Anesthesia, Conduction, Postoperative Pain
- Medical subject headings
- Pain, Postoperative
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Parasacral Ischial Plan BlockProcedure or surgery
The sacral plexus is located within a fascial plane formed by the pelvic fascia anteriorly, the sacrum medially, the piriformis and gluteus maximus muscles posteriorly, and the ischium laterally. The piriformis muscle has no attachment to the ischium and attaches to the greater trochanter laterally. A fascial plane exists between the piriformis muscle and the ischium; this fascial plane extends to the sacral plexus.
Venkataraju et al. stated that in PIP block demonstrations, the needle should be directed and placed towards the posteromedial surface of the ischium. After bone contact, the medication was injected, and it was observed that the medication spread from under the piriformis muscle towards the sacral plexus.
Sacral plexus blockProcedure or surgery
This block, defined by the parasacral approach, targets the exit point of the plexus at the level of the foramen ischiadicum majus. Unlike distal sciatic blocks, blocking at this level includes the posterior cutaneous femoral nerve, superior/inferior gluteal nerve, and pudendal nerve, along with the ischial nerve. In current practice, ultrasonography (USG) has become the "gold standard"; visualizing the neural structures deep to the piriformis muscle by placing the probe between the lateral sacrum and the iliac wing increases the success rate while minimizing the risk of complications.
| Study group | Role | What they receive |
|---|---|---|
| Parasacral Ischial Plan Block | Active comparator | A novel ultrasound-guided fascial plane approach to the sacral plexus, called the Parasacral-Ischial Plane (PIP) block, has been successfully studied in a small number of patients. The sacral plexus is located within a fascial plane formed by the pelvic fascia anteriorly, the sacrum medially, the piriformis and gluteus maximus muscles posteriorly, and the ischium laterally. The piriformis muscle has no attachment to the ischium and attaches to the greater trochanter laterally. A fascial plane exists between the piriformis muscle and the ischium; this fascial plane extends to the sacral plexus.
Venkataraju et al. stated that in a PIP block demonstration, the needle should be directed and placed towards the posteromedial surface of the ischium. After bone contact, medication was injected, and it was observed that the medication spread from under the piriformis muscle towards the sacral plexus. This method is considered easier and less risky. Receives: Procedure: Parasacral Ischial Plan Block |
| Sacral plexus block | Active comparator | This block, defined by the parasacral approach, targets the exit point of the plexus at the level of the foramen ischiadicum majus. Unlike distal sciatic blocks, blocking at this level includes the posterior cutaneous femoral nerve, superior/inferior gluteal nerve, and pudendal nerve, along with the ischial nerve. In current practice, ultrasonography (USG) has become the "gold standard"; visualizing the neural structures deep to the piriformis muscle by placing the probe between the lateral sacrum and the iliac wing increases the success rate while minimizing the risk of complications. Receives: Procedure: Sacral plexus block |
What is being measured
The primary outcome is the main question the study is designed to answer.
Sensory and motor block onset time
This approach is based on the volume-dependent spread of local anesthetic into the plane between the sacral plexus and the deep pelvic muscle fascia; sensory blockade begins proximally to distally within 10-20 minutes, while motor blockade usually develops later and gradually around 20-30 minutes.
Measured: 1 hour
Secondary outcomes (1)
The Numerical Rating Scale (NRS)
Pain control is a one-dimensional measurement tool, usually ranging from 0 to 10, used to subjectively assess a patient's pain intensity. In academic literature, this scale, expressed with integers from 0 (no pain) to 10 (the most severe pain imaginable), is considered a fundamental parameter for pain monitoring in clinical research and perioperative processes due to its high validity, ease of application, and flexibility in verbal or written form.
Measured: 1 Day
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted18 May 2026
- Study start1 May 2026 (estimated)
- Primary completion1 May 2027 (estimated)
- Study completion1 May 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (6)Papers the sponsor has linked to this study.
- Other trials for Patients Scheduled for Elective Lower Extremity SurgeryStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Comparison of methods between 2 groups.
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Bursa Yuksek Ihtisas Training and Research Hospital
- Sponsor type
- Other government
- Responsible party
- Principal investigator, Nurullah Damla, Bursa Yuksek Ihtisas Training and Research Hospital
- Investigators
- Korgün Ökmen, Study director, Bursa Yuksek Ihtisas Training and Research Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07594197
- Sponsor's protocol ID
- BursaYIERH-AR-ND-01
- Status last verified
- May 2026
- First submitted
- 5 May 2026
- Last updated
- 18 May 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: due to patient privacy
Publications
Enneking FK, Chan V, Greger J, Hadzic A, Lang SA, Horlocker TT. Lower-extremity peripheral nerve blockade: essentials of our current understanding. Reg Anesth Pain Med. 2005 Jan-Feb;30(1):4-35. doi: 10.1016/j.rapm.2004.10.002. No abstract available.
PubMed 15690265Zhao J, Huang Y, Fu M, Tao F. Ultrasound-guided suprainguinal fascia iliaca block combined with a sacral plexus block for lower extremity surgery: A case report. Medicine (Baltimore). 2020 Aug 28;99(35):e21921. doi: 10.1097/MD.0000000000021921.
PubMed 32871928Arjun BK, Prijith RS, Sreeraghu GM, Narendrababu MC. Ultrasound-guided popliteal sciatic and adductor canal block for below-knee surgeries in high-risk patients. Indian J Anaesth. 2019 Aug;63(8):635-639. doi: 10.4103/ija.IJA_296_19.
PubMed 31462809Chia N, Low TC, Poon KH. Peripheral nerve blocks for lower limb surgery--a choice anaesthetic technique for patients with a recent myocardial infarction? Singapore Med J. 2002 Nov;43(11):583-6.
PubMed 12680529Bech B, Melchiors J, Borglum J, Jensen K. The successful use of peripheral nerve blocks for femoral amputation. Acta Anaesthesiol Scand. 2009 Feb;53(2):257-60. doi: 10.1111/j.1399-6576.2008.01859.x.
PubMed 19175579Venkataraju A, Narayanan M, Phillips S. Parasacral ischial plane (PIP) block: An easy approach to sacral plexus. J Clin Anesth. 2020 Feb;59:103-105. doi: 10.1016/j.jclinane.2019.06.030. Epub 2019 Jul 16. No abstract available.
PubMed 31323463
Study at a glance
From the registry record, last updated by the sponsor on 18 May 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Evaluation of Sensory and Motor Blockade of Ultrasound-Guided Parasacral Ischial Plane Block in Lower Extremity Surgery
- ClinicalTrials.gov ID
- NCT07594197
- Acronym / sponsor ID
- BursaYIERH-AR-ND-01
- Conditions
- Patients Scheduled for Elective Lower Extremity Surgery, Ages 18-80, ASA I-III, Patients Operated on Under Regional Anesthesia, Patients Who Provided Written Informed Consent
- Keywords
- Lumbosacral Plexus, Anesthesia, Conduction, Postoperative Pain
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 60 participants (estimated)
- Lead sponsor
- Bursa Yuksek Ihtisas Training and Research HospitalOther government
- Study start
- 1 May 2026 (estimated)
- Primary completion
- 1 May 2027 (estimated)
- Study completion
- 1 May 2027 (estimated)
- First posted
- 18 May 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The parasacral ischial plane block is a novel fascial plane approach targeting the sacral plexus. This technique is technically less challenging and eliminates the requirement for direct visualization of the sacral plexus. The aim of this prospective observational study is to evaluate the efficacy of the conventional sacral plexus block versus the parasacral ischial plane block in patients undergoing lower extremity surgery.
Detailed description
Sympatholysis resulting from central neuraxial block or general anesthesia in lower extremity surgeries may lead to adverse hemodynamic changes and increased perioperative mortality, particularly in high-risk patients. In such patients, lower extremity procedures can be successfully performed solely under sciatic and femoral nerve blocks. Depending on the surgical indication, the sciatic nerve block may be utilized alone or in combination with a lumbar plexus or femoral nerve block.A novel ultrasound-guided (USG) fascial plane approach targeting the sacral plexus, termed the Parasacral Ischial Plane (PIP) block, has been successfully investigated in a limited number of patients. The sacral plexus is located within a fascial plane formed by the pelvic fascia anteriorly, the sacrum medially, the piriformis and gluteus maximus muscles posteriorly, and the ischium bone laterally. The piriformis muscle has no attachment to the ischium; instead, it attaches laterally to the greater trochanter. A fascial plane exists between the piriformis muscle and the ischium, which extends directly to the sacral plexus.
Venkataraju et al. stated that during the demonstration of the PIP block, the needle should be directed and positioned toward the posteromedial surface of the ischium. Following bony contact, the injectate was administered, and its spread was observed beneath the piriformis muscle toward the sacral plexus (SP). This method is considered to be technically more straightforward and carries a lower risk profile.
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, investigator)
- Number of arms
- 2
- Model description
- Comparison of methods between 2 groups.
| Arm | Type | Receives |
|---|---|---|
| Parasacral Ischial Plan Block | Active comparator | Procedure: Parasacral Ischial Plan BlockA novel ultrasound-guided fascial plane approach to the sacral plexus, called the Parasacral-Ischial Plane (PIP) block, has been successfully studied in a small number of patients. The sacral plexus is located within a fascial plane formed by the pelvic fascia anteriorly, the sacrum medially, the piriformis and gluteus maximus muscles posteriorly, and the ischium laterally. The piriformis muscle has no attachment to the ischium and attaches to the greater trochanter laterally. A fascial plane exists between the piriformis muscle and the ischium; this fascial plane extends to the sacral plexus. Venkataraju et al. stated that in a PIP block demonstration, the needle should be directed and placed towards the posteromedial surface of the ischium. After bone contact, medication was injected, and it was observed that the medication spread from under the piriformis muscle towards the sacral plexus. This method is considered easier and less risky. |
| Sacral plexus block | Active comparator | Procedure: Sacral plexus blockThis block, defined by the parasacral approach, targets the exit point of the plexus at the level of the foramen ischiadicum majus. Unlike distal sciatic blocks, blocking at this level includes the posterior cutaneous femoral nerve, superior/inferior gluteal nerve, and pudendal nerve, along with the ischial nerve. In current practice, ultrasonography (USG) has become the "gold standard"; visualizing the neural structures deep to the piriformis muscle by placing the probe between the lateral sacrum and the iliac wing increases the success rate while minimizing the risk of complications. |
Who may qualify
- Ages
- 18 to 80 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Ages 18-80
- ASA I-III
- Patients operated on under regional anesthesia
- Patients who provided written informed consent
- Patients scheduled for elective lower extremity surgery -
Key exclusion criteria (8 listed)
- Patients with a history of allergy to local anesthetic drugs
- Patients with coagulation disorders
- Patients with BMI > 40 kg/m²
- Presence of infection at the block application site
- Chronic pain syndrome (chronic opioid use)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Parasacral Ischial Plan BlockThe sacral plexus is located within a fascial plane formed by the pelvic fascia anteriorly, the sacrum medially, the piriformis and gluteus maximus muscles posteriorly, and the ischium laterally. The piriformis muscle has no attachment to the ischium and attaches to the greater trochanter laterally. A fascial plane exists between the piriformis muscle and the ischium; this fascial plane extends to the sacral plexus. Venkataraju et al. stated that in PIP block demonstrations, the needle should be directed and placed towards the posteromedial surface of the ischium. After bone contact, the medication was injected, and it was observed that the medication spread from under the piriformis muscle towards the sacral plexus. | Procedure or surgery | Parasacral Ischial Plan Block |
| Sacral plexus blockThis block, defined by the parasacral approach, targets the exit point of the plexus at the level of the foramen ischiadicum majus. Unlike distal sciatic blocks, blocking at this level includes the posterior cutaneous femoral nerve, superior/inferior gluteal nerve, and pudendal nerve, along with the ischial nerve. In current practice, ultrasonography (USG) has become the "gold standard"; visualizing the neural structures deep to the piriformis muscle by placing the probe between the lateral sacrum and the iliac wing increases the success rate while minimizing the risk of complications. | Procedure or surgery | Sacral plexus block |
Primary outcome
Sensory and motor block onset time
Time frame: 1 hour
This approach is based on the volume-dependent spread of local anesthetic into the plane between the sacral plexus and the deep pelvic muscle fascia; sensory blockade begins proximally to distally within 10-20 minutes, while motor blockade usually develops later and gradually around 20-30 minutes.
1 secondary outcome
The Numerical Rating Scale (NRS)
Time frame: 1 Day
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 18 May 2026.
- Background: PubMed 15690265Enneking FK, Chan V, Greger J, Hadzic A, Lang SA, Horlocker TT. Lower-extremity peripheral nerve blockade: essentials of our current understanding. Reg Anesth Pain Med. 2005 Jan-Feb;30(1):4-35. doi: 10.1016/j.rapm.2004.10.002. No abstract available.
- Background: PubMed 32871928Zhao J, Huang Y, Fu M, Tao F. Ultrasound-guided suprainguinal fascia iliaca block combined with a sacral plexus block for lower extremity surgery: A case report. Medicine (Baltimore). 2020 Aug 28;99(35):e21921. doi: 10.1097/MD.0000000000021921.
- Background: PubMed 31462809Arjun BK, Prijith RS, Sreeraghu GM, Narendrababu MC. Ultrasound-guided popliteal sciatic and adductor canal block for below-knee surgeries in high-risk patients. Indian J Anaesth. 2019 Aug;63(8):635-639. doi: 10.4103/ija.IJA_296_19.
- Background: PubMed 12680529Chia N, Low TC, Poon KH. Peripheral nerve blocks for lower limb surgery--a choice anaesthetic technique for patients with a recent myocardial infarction? Singapore Med J. 2002 Nov;43(11):583-6.
- Background: PubMed 19175579Bech B, Melchiors J, Borglum J, Jensen K. The successful use of peripheral nerve blocks for femoral amputation. Acta Anaesthesiol Scand. 2009 Feb;53(2):257-60. doi: 10.1111/j.1399-6576.2008.01859.x.
- Background: PubMed 31323463Venkataraju A, Narayanan M, Phillips S. Parasacral ischial plane (PIP) block: An easy approach to sacral plexus. J Clin Anesth. 2020 Feb;59:103-105. doi: 10.1016/j.jclinane.2019.06.030. Epub 2019 Jul 16. No abstract available.
- Individual participant dataSharing planned: No. due to patient privacy
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Korgün Ökmen study director
Bursa Yuksek Ihtisas Training and Research Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Parasacral Ischial Plan Block and Sacral plexus block in people with Patients Scheduled for Elective Lower Extremity Surgery and Ages 18-80, run by Bursa Yuksek Ihtisas Training and Research Hospital at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 18 May 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact NURULLAH DAMLA (+905075482122, nurullahdamla@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Sensory and motor block onset time (time frame: 1 hour). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07594197, which also lists 6 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 May 2026.