Background and Aims Intra-operative hypotension (IOH) is associated with a significant increase in post-operative morbidity and mortality in non-cardiac surgery. There’s no consensus concerning the best anesthesia technique for traumatic leg and ankle surgery. We hypothesize that peripheral nerve blocks (PNB) decrease the risk of intra-operative hypotension episods and treatment compared to GA.

Methods Using a propensity score-matched analysis, we compared a GA group and a PNB group in terms of vasopressors consumption (primary end point), incidence of IOH under a MAP at 65mmHg, IOH under a MAP at 50mmHg (secondary end points) and post-operative complications within 30 days after surgery.

Results After informed consent and clinical trials.gov registration, 259 patients were assessed for eligibility and 250 were allocated in the both groups ( 105 GA and 145 BNP) for analysis. After propensity score matching, 33 patients in each group were compared. There’s no difference in demographic characteristics, comorbidities, preoperative medications or type of surgery. The use of vasopressors was significantly higher in the GA group (15/33 (46%)) than in PNB group (1/33 (3%)); p=0,0002 (Table 1) .The incidence of IOH episods under 65mmHg and 50mmHg of MAP was significantly higher in the GA group compared to PNB group: respectively, 94% vs 18% for 65mmHg and 27% vs 3% for 50mmHg,p <0,0001 and p<0,0114. No difference were reported for post-operative complications in both groups.

Conclusions The use of PNB decrease the use of vasopressors and provide a safer hemodynamic stability compared to GA in patients scheduled for traumatic ankle and leg surgery.