Background and Aims Hip fracture (HF) is common in emergency departments admission Mortality can reach 32% one year after surgery and delirium may affect 41% post-operative. Search for improved benefits from spinal (SP) or general anesthesia have shown inconsistent results. We aim to test if peripheral nerve blocks (PNB) with general inhalational anesthesia (GA), avoiding muscle relaxants and reducing opioids usage, may improve survival and delirium after HF repair when compared to spinal.
Methods Hospital Ethics approval and patient informed consent were obtained. HF patients were randomized to Femoral and Lateral Cutaneous nerve block (PNB) with GA versus SP, for surgical repair (Hip prothesis, dynamic screw or femoral nail). Clinical data was collected throughout peri-operative period. CAM test was used to asses delirium and one year follow-up to assess survival. Descriptive statistics was used to characterize the sample and parametric and non-parametric tests were used to assess differences between groups.
Results Groups demographics are in table 1. All ASA 4 patients were on the GA/PNB group, but the Man-Whitney test shows no difference in ASA distribution overall. Overall, 37% of patients had delirium up to 3 days after surgery and one year mortality was 19.3%.Table 2 shows the differences between PNB/GA and SP groups.
Conclusions Overall survival and delirium rates are within the literature range. Although a trend to higher 1year mortality can be seen in the BNP/AG group, we did not find statistical differences in outcomes using peripheral nerve block/general inhalational anesthesia vs spinal. A larger study is needed to confirm these findings
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