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Liu S, Chen J, Shi H, Li J, Zeng G, Liu W, Hu W, Li S, Gao W, Song W, Liang A, Chen Y. Comparing perioperative outcomes between regional anesthesia and general anesthesia in patients undergoing hip fracture surgery: a systematic review and meta-analysis. Can J Anaesth 2024; 71:849-869. [PMID: 38418761 DOI: 10.1007/s12630-024-02696-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 03/02/2024] Open
Abstract
PURPOSE Nearly all patients with hip fractures undergo surgical treatment. The use of different anesthesia techniques during surgery may influence the clinical outcomes. The optimal anesthetic technique for patients undergoing hip fracture surgery is still controversial. We performed this updated systematic review and meta-analysis to compare clinical outcomes of patients undergoing hip fracture surgery with different anesthesia techniques. SOURCE Articles published from 2000 to May 2023 were included from MEDLINE, Embase, Web of Science, and the Cochrane Library. We included randomized controlled trials and observational studies comparing general anesthesia (GA) with regional anesthesia (RA) for the outcomes of 30-day mortality, 90-day mortality, in-hospital mortality, perioperative complications, length of hospital stay, and length of surgery in patients undergoing hip fracture surgery. Subgroup analyses were performed for the outcomes based on study design (randomized controlled trials or observational studies). We used a random-effects model for all analyses. PRINCIPAL FINDINGS In this meta-analysis, we included 12 randomized controlled trials. There was no difference in postoperative 30-day mortality between the two groups (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.44 to 1.74; I2 = 0%). The incidence of intraoperative hypotension was lower in patients who received RA vs GA (OR, 0.52; 95% CI, 0.38 to 0.72; I2 = 0%). No significant differences were observed in 90-day mortality, in-hospital mortality, postoperative delirium, pneumonia, myocardial infarction, venous thromboembolism, length of surgery, and length of hospital stay. CONCLUSION In this updated systematic review and meta-analysis, RA did not reduce postoperative 30-day mortality in hip fracture surgery patients compared to GA. Fewer patients receiving RA had intraoperative hypotension than those receiving GA did. Apart from intraoperative hypotension, the data showed no differences in complications between the two anesthetic techniques. STUDY REGISTRATION PROSPERO (CRD42023411854); registered 7 April 2023.
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Affiliation(s)
- Song Liu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianan Chen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huihong Shi
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianhong Li
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gang Zeng
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenzhou Liu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenjun Hu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaoguang Li
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenjie Gao
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weidong Song
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Anjing Liang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanbo Chen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Yingfeng Road, 33th Haizhu District, Guangzhou, 510000, China.
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Salgado-García D, Díaz-Álvarez A, González-Rodríguez JL, López-Iglesias MR, Sánchez-López E, Sánchez-Ledesma MJ, Martínez-Trufero MI. Comparison of the Analgesic Efficacy between Levobupivacaine 0.25% and Ropivacaine 0.375% for PENG (Pericapsular Nerve Group) Block in the Context of Hip Fracture Surgery of Elderly Patients: A Single-Center, Randomized, and Controlled Clinical Trial. J Clin Med 2024; 13:770. [PMID: 38337464 PMCID: PMC10856763 DOI: 10.3390/jcm13030770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Previous studies have compared levobupivacaine versus ropivacaine in various peripheral nerve blocks in terms of block duration, quality of analgesia, and onset time, but this has not occurred in the PENG block. Here, a single-center, randomized, and controlled clinical trial is presented. One hundred and twenty patients older than 65 years suffering from hip fractures and surgically treated at our institution under spinal anesthesia were eligible for participation; of them, one hundred and eight were analyzed. Patients were randomized to receive ultrasound-guided PENG blocks using 20 mL of either 0.25% levobupivacaine or 0.375% ropivacaine (both of which are equipotent concentrations). The primary endpoint was to compare the analgesic duration (time to first rescue) and analgesic quality (pain scores using the VAS, PAINAD, and AlgoPlus scales) between the groups. Secondary endpoints included comparing the onset time, describing the need for and type of rescue analgesics, and possible associated adverse effects. There were no statistically significant differences in analgesic duration between levobupivacaine (median 861.0, IQR 960) and ropivacaine (median 1205.0, IQR 1379; p = 0.069). Likewise, the quality of analgesia and onset time were comparable among the groups. A small number of patients required opioids as rescue analgesics (4.6%). The possible associated adverse effects included postoperative infection (11.1%) and delirium (2.8%).
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Affiliation(s)
- Daniel Salgado-García
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
| | - Agustín Díaz-Álvarez
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
- Department of Surgery, Faculty of Medicine, Salamanca University, Calle Alfonso X el Sabio, 37007 Salamanca, Castilla y León, Spain
- Instituto de Investigación Biomédica de Salamanca de la FIESCYL (IBSAL-FIESCYL), Paseo de San Vicente 182, 37007 Salamanca, Castilla y León, Spain
| | - José Luis González-Rodríguez
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
- Instituto de Investigación Biomédica de Salamanca de la FIESCYL (IBSAL-FIESCYL), Paseo de San Vicente 182, 37007 Salamanca, Castilla y León, Spain
| | - María Rocío López-Iglesias
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
- Instituto de Investigación Biomédica de Salamanca de la FIESCYL (IBSAL-FIESCYL), Paseo de San Vicente 182, 37007 Salamanca, Castilla y León, Spain
| | - Eduardo Sánchez-López
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
| | - Manuel Jesús Sánchez-Ledesma
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
- Department of Surgery, Faculty of Medicine, Salamanca University, Calle Alfonso X el Sabio, 37007 Salamanca, Castilla y León, Spain
- Instituto de Investigación Biomédica de Salamanca de la FIESCYL (IBSAL-FIESCYL), Paseo de San Vicente 182, 37007 Salamanca, Castilla y León, Spain
| | - María Isabel Martínez-Trufero
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
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Weinstein ER, Boyer RB, White RS, Weinberg RY, Lurie JM, Salvatierra N, Tedore TR. Improved outcomes for spinal versus general anesthesia for hip fracture surgery: a retrospective cohort study of the National Surgical Quality Improvement Program. Reg Anesth Pain Med 2024; 49:4-9. [PMID: 37130697 DOI: 10.1136/rapm-2022-104217] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/05/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND There is a lack of consensus in the literature as to whether anesthetic modality influences perioperative complications in hip fracture surgery. The aim of the present study was to assess the effect of spinal anesthesia compared with general anesthesia on postoperative morbidity and mortality in patients who underwent hip fracture surgery using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). METHODS We used the ACS NSQIP to identify patients aged 50 and older who received either spinal or general anesthesia for hip fracture surgery from 2016 to 2019. Propensity-score matching was performed to control for clinically relevant covariates. The primary outcome of interest was the combined incidence of stroke, myocardial infarction (MI) or death within 30 days. Secondary outcomes included 30-day mortality, hospital length of stay and operative time. RESULTS Among the 40 527 patients aged 50 and over who received either spinal or general anesthesia for hip fracture surgery from 2016 to 2019, 7358 spinal anesthesia cases were matched to general anesthesia cases. General anesthesia was associated with a higher incidence of combined 30-day stroke, MI or death compared with spinal anesthesia (OR 1.219 (95% CI 1.076 to 1.381); p=0.002). General anesthesia was also associated with a higher frequency of 30-day mortality (OR 1.276 (95% CI 1.099 to 1.481); p=0.001) and longer operative time (64.73 vs 60.28 min; p<0.001). Spinal anesthesia had a longer average hospital length of stay (6.29 vs 5.73 days; p=0.001). CONCLUSION Our propensity-matched analysis suggests that spinal anesthesia as compared with general anesthesia is associated with lower postoperative morbidity and mortality in patients undergoing hip fracture surgery.
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Affiliation(s)
- Eliana R Weinstein
- Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Richard B Boyer
- Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Robert S White
- Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Roniel Y Weinberg
- Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Jacob M Lurie
- Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Nicolas Salvatierra
- Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Tiffany R Tedore
- Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
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