Hypobaric Unilateral Spinal Anaesthesia versus General Anaesthesia in Elderly Patients Undergoing Hip Fracture Surgical Repair:  A Prospective Randomised Open Trial

Meuret, Pascal; Bouvet, Lionel; Villet, Benoit; Hafez, Mohamed Abdel; Allaouchiche, Bernard; Boselli, Emmanuel

doi:10.5152/tjar.2018.90699

Cited by 19 publications

(26 citation statements)

References 45 publications

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“…Eight studies were excluded because four of them included no control groups, and others provided inadequate data. Finally, nine RCTs with a total of 1084 patients between 2003 and 2018 met our inclusion criteria, and were included in the meta-analysis [13][14][15][16][17][18][19][20][21]. The flow diagram of study selection is shown in Fig.…”

Section: Study Identification and Selectionmentioning

confidence: 99%

Comparative efficacy of Neuraxial and general anesthesia for hip fracture surgery: a meta-analysis of randomized clinical trials

et al. 2020

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Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery. Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. Sensitivity analyses were conducted using a Bonferroni correction and the leave-one-out method. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The outcomes for the meta-analysis showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = − 0.65, 95% CI-0.32, 0.02; P = 0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia, and there was a significant difference in blood loss between the two groups (MD = − 137.8, 95% CI-241.49, − 34.12; p = 0.009). However, after applying the Bonferroni correction for multiple testing, all the adjusted p-values were above the significant threshold of 0.05. The evidence quality for each outcome evaluated by the GRADE system was low. Conclusions: In summary, our present study demonstrated that there might be a difference in blood loss between patients receiving neuraxial and general anaesthesia, however, this analysis was not robust to adjustment for multiple testing and therefore at high risk for a type I error. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue.

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Section: Study Identification and Selectionmentioning

confidence: 99%

Comparative efficacy of Neuraxial and general anesthesia for hip fracture surgery: a meta-analysis of randomized clinical trials

et al. 2020

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“…Eight studies were excluded because four of them included no control groups, and others provided inadequate data. Finally, nine RCTs with a total of 1084 patients between 2003 and 2018 met our inclusion criteria, and were included in the meta-analysis [13][14][15][16][17][18][19][20][21] . The ow diagram of study selection is shown in Fig.…”

Section: Study Identi Cation and Selectionmentioning

confidence: 99%

“…Thus a xed effect model was used to analyze the results.The pooled data revealed that no signi cant difference was detected in the length of stay between the two groups (MD = -0.65, 95% CI -0.32, 0.02; P =0.06, Fig. 8) Two studies were included in the meta-analysis for deep venous thrombosis rate, involving 179 patients in the neuraxial anesthesia group and 183 patients in the general anesthesia group 18,20 . The P value with the Cochran's Q test was 0.60, and the I 2 statistic was 0%, which indicated low heterogeneity among these studies.…”

Section: Outcomes For Meta-analysismentioning

confidence: 99%

Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

Zheng

Tang

Gao

et al. 2020

Preprint

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Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery.Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were conducted using a Bonferroni correction and the leave-one-out method. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The outcomes for the meta-analysis showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = -0.65, 95% CI -0.32, 0.02; P =0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia, and there was a significant difference in blood loss between the two groups (MD = -137.8, 95% CI -241.49, -34.12; p = 0.009). However, after applying the Bonferroni correction for multiple testing, all the adjusted p-values were above the significant threshold of 0.05. The evidence quality for each outcome evaluated by the GRADE system was low.Conclusions: In summary, our present study demonstrated that there might be a difference in blood loss between patients receiving neuraxial and general anaesthesia, however, this analysis was not robust to adjustment for multiple testing and therefore at high risk for a type I error. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue.

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“…There were a total of 1084 patients, whose ages were older than 49 years-old. Seven studies looked at outcomes relating to spinal anesthesia compared with general anesthesia 13,14,[16][17][18][19]21 , one study examed outcomes for hypobaric unilateral spinal anesthesia and general anesthesia 20 , and the other study compared general versus neuraxial anesthesia that encompassed spinal and epidural anesthesia 15 . In the terms of surgery type, two studies performed arthroplasty, hip screw and intramedullary nail 18,20 ; two studies included hemiarthroplasty only 13,14 , and one study performed hemiarthroplasty and Intramedullary nail 16 .…”

Section: Study Characteristicsmentioning

confidence: 99%

Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

Zheng

Tang

Gao

et al. 2019

Preprint

View full text Add to dashboard Cite

Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery. Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were performed by the leave-one-out approach. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The results showed that there were no significant differences in the 30-day mortality, length of stay, and the prevalence of delirium, acute myocardial infarction, and pneumonia for neuraxial anesthesia compared to general anesthesia. There was a significant difference in terms of blood loss in favor of the neuraxial anesthesia. The evidence quality for each outcome evaluated by the GRADE system was low. Conclusions: In summary, our present study demonstrated that neuraxial anesthesia is significantly superior to general anesthesia regarding blood loss in patients undergoing hip fracture surgery. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to to clarify this issue.

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Hypobaric Unilateral Spinal Anaesthesia versus General Anaesthesia in Elderly Patients Undergoing Hip Fracture Surgical Repair: A Prospective Randomised Open Trial

Abstract: This study shows that HUSA provides better haemodynamic stability than GA, with lower consumption of ephedrine and similar operating conditions. This new approach of spinal anaesthesia seems to be safe and effective in elderly patients undergoing hip fracture surgery.

Cited by 19 publications

References 45 publications

Comparative efficacy of Neuraxial and general anesthesia for hip fracture surgery: a meta-analysis of randomized clinical trials

Comparative efficacy of Neuraxial and general anesthesia for hip fracture surgery: a meta-analysis of randomized clinical trials

Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

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