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

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.

A Comparison of the Effect on Postoperative Pain between Lateral Femoral Cutaneous Nerve Block and Local Infiltration Anesthesia after Total Hip Arthroplasty: A Randomized Trial

“…"Superficially, femoral nerve and lateral femoral cutaneous nerve innervate the anterior and lateral thigh, which meets the need for hip surgery incision in most cases. In a deep layer, the hip joint is innervated by the articular branches of obturator, femoral, sciatic, and gluteal nerves, so the FNB provided some analgesia for the hip" [2]. Supplemental single shot FNB shows beneficial effects on postoperative management and recovery after THA [6].…”

“…Second limitation is that because the study did not have control patients without any nerve blocks including femoral nerve block. However, the patients without any nerve block would feel severe pain because FNB have some analgesia after THA [2].…”

“…"Owing to the complex sensory innervations of the hip joint, no single nerve block allows sufficient analgesia. The combination of multiple nerve blocks plays an essential role in general anesthesia" [2]. "Peripheral nerve blocks used for postoperative pain management after THA include femoral nerve block (FNB), fascia iliaca block, and lumbar plexus block" [3].…”

Ultrasound-guided anterior iliopsoas muscle space block effectively reduces intraoperative hypotension in elderly adults undergoing hip surgery: A randomised controlled trial

“…Compared with the previous two techniques, conventional posterior lumbosacral plexus block with laryngeal-mask general anaesthesia provided adequate pain relief during surgery, shortened hospital stays, and decreased mortality ( Chen et al, 2018 ; Scurrah et al, 2018 ). However, the posterior lumbosacral plexus also has some disadvantages, such as multiple puncture injections, turning over to change the patient’s position, and intraoperative hypotension (IOH; Aksoy et al, 2014 ; Zhang et al, 2022 ), which may be due to the diffusing local anaesthetics into the epidural area, sympathetic nerve block, or excessive analgesia ( Lee and Braehler, 2017 ).…”

Comparison of Femoral Neck System versus Cannulated Screws for Treatment of Femoral Neck Fractures: A Systematic Review and Meta-Analysis

“…Cannulated screws (CS) are currently among the most widely used implants in clinical practice [9,10]. It has the advantages of minor soft tissue damage, low bleeding, and reliable xation, but it has poor stability in unstable fracture types [11].…”