A Comparison of Two Peripheral Nerve Blocks Combined With General Anesthesia in Elderly Patients Undergoing Arthroplasty for Hip Fractures: A Pilot Randomized Controlled Trial.

Qingfu Zhang,Derong Cui,Xintao Wang,Ming Ling

doi:10.3389/fsurg.2022.715422

Abstract

BackgroundCombined anesthesia can be a promising option for hip surgery when neuraxial anesthesia is contraindicated. Lumbar and sacral plexus blocks, and femoral nerve and lateral femoral cutaneous (LFC) nerve blocks in combination with general anesthesia (GA) are commonly used in elderly patients undergoing arthroplasty for hip fracture surgery. However, no study has compared these two anesthetic strategies in the perioperative period.MethodsA total of 41 elderly patients scheduled for arthroplasty for hip fracture surgery were randomized into group A (n = 20) and group B (n = 21). Group A received femoral nerve block, LFC nerve blocks, and GA, and group B received lumbar plexus block, sacral plexus block, and GA. Primary outcomes were incidences of hemodynamic events and changes in blood pressure (BP) and heart rate (HR). Secondary outcomes included time and drug consumption, infusion and bleeding volume, eyes opening time after surgery, and postoperative quality recovery rate.ResultsCompared with group B, group A showed a lower incidence of intraoperative hypotension (p < 0.001), higher BP [including mean arterial pressure (MAP), systolic BP (SBP), and diastolic BP (DBP)] following induction (IN), and higher HR from mid-surgery. Time required for nerve blockade (p < 0.001) and ephedrine consumption was significantly shorter in group A (p < 0.001), while sufentanil consumption was higher as compared to group B (p = 0.002). No significant differences in other intraoperative parameters and postoperative quality recovery rate were reported during the observation.ConclusionOur pilot data indicate that compared with lumbar and sacral plexus blocks, femoral nerve and LFC nerve blocks may provide more stable intraoperative hemodynamics and a comparable postoperative recovery for elderly patients undergoing arthroplasty for hip fracture under GA. Further studies with a larger sample size are needed to derive stronger evidence.

Highlights

Combined anesthesia can be a promising option for hip surgery when neuraxial anesthesia is contraindicated
Between-group comparison revealed no significant differences in demographic data, such as sex, age, height, weight, body mass index (BMI), years of education, injured side, fracture type, and American Society of Anesthesiologists (ASA) grade (Table 1)
We reported that femoral nerve and lateral femoral cutaneous (LFC) nerve blocks plus general anesthesia (GA) demonstrated more stable intraoperative hemodynamics characterized by higher blood pressure (BP) and fewer hypotension, and both strategies achieved similar outcomes in short-term postoperative recovery

Summary

Introduction

Combined anesthesia can be a promising option for hip surgery when neuraxial anesthesia is contraindicated. Lumbar and sacral plexus blocks, and femoral nerve and lateral femoral cutaneous (LFC) nerve blocks in combination with general anesthesia (GA) are commonly used in elderly patients undergoing arthroplasty for hip fracture surgery. Studies show that patients who undergo hip fracture surgery have an increasing chance of accompanying multiple comorbidities that may complicate anesthesia and analgesia for these patients [4]. Satisfactory anesthesia is patient-specific as well as anesthesiologist-specific, and the ideal treatment technique for elderly patients with hip fracture remains controversial. Both general anesthesia (GA) and neuraxial anesthesia have been widely used till date. The combination of multiple peripheral nerve blocks (PNBs) plays an essential role in using RA alone or in combination with GA

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