Abstract
Purpose Hip fracture is a common injury in geriatric populations, which is associated with poor quality of life. However, the ideal anesthesia technique for this disease is yet to be identified. This study aimed to compare the combined lumbar-sacral plexus block (CLSB) plus general anesthesia (bispectral index (BIS) 60–80) with the unilateral spinal anesthesia (SA) on activity of daily living in elderly patients undergoing hip fracture surgery. Methods A total of 124 elderly patients undergoing hip fracture surgery were randomly assigned to two groups. Patients in the SA group received light-specific gravity spinal anesthesia, and patients in the CLSB group received lumbar and sacral plexus block with general anesthesia (BIS 60–80). The primary outcomes were 30-day activity of daily living (ADL). The secondary outcomes were postoperative pain scores, postoperative delirium, in-hospital cost, and major complications. Results The ADL scores of postoperative day 30 (POD30) in the CLSB group are higher than those in the SA group (27.34 ± 7.01 versus 24.70 ± 6.40, P=0.045). Compared to preoperative ADL scores, there were higher increased scores in the CLSB group than in POD30 (CLSB group 8.09 ± 3.39 versus SA group 4.87 ± 3.90, P < 0.001). Mild-to-moderate pain did not have differences between the two groups (rest pain: 3 versus 2, P=0.344; motion pain: 5 versus 4, P=0.073). There were no significant differences in incidence of postoperative delirium, PONV, and other complications. Conclusion The unilateral SA can reduce the deterioration of ADL after hip fracture surgery and provide a better postoperative recovery.
Highlights
Hip fracture is a common injury in geriatric populations, ranking the second among the causes of hospitalization and disability for elderly patients
124 patients were randomly assigned to spinal anesthesia (SA) and combined lumbar-sacral plexus block (CLSB) groups
In the CLSB group, four patients were lost to follow-up and three patients were switched to general anesthesia
Summary
Hip fracture is a common injury in geriatric populations, ranking the second among the causes of hospitalization and disability for elderly patients It has critical consequences of deteriorated function status, for example, increasing mortality and decreasing quality of life [1, 2]. Evidence to clarify the influence of different types of anesthesia on postoperative ADL is still lacking Both the combined lumbar and sacral plexus block (CLSB) with general anesthesia (BIS 60–80) and the unilateral spinal anesthesia (SA) on the operative side had been reported to be safe and effective as regional anesthesia techniques for hip surgery [9,10,11]. Evidence-Based Complementary and Alternative Medicine anesthesia (BIS 60–80) and the unilateral spinal anesthesia plus monitored anesthesia care (MAC) on the postoperative ADL of elderly patients undergoing hip fracture surgery. Mechanical ventilation was set as follows: the tidal volume was set as 6–8 mL/kg, the respiratory rate was set as 10–12 breaths/min, the ratio of expiration: inspiration was set as 2 : 1, and the end-tidal carbon dioxide pressure remained at 35–40 mmHg. e effect-site concentration of propofol was adjusted to maintain the depth of sedation (BIS: 60–80) [10]. e depth of sedation was assessed by observer’s assessment of alertness/sedation (OAA/S) as a supplement
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