Regional anesthesia showed no consistent mortality or postoperative delirium benefit over general anesthesia in geriatric hip fracture patients, though peripheral nerve blocks improved analgesia.
Does regional anesthesia improve perioperative outcomes compared to general anesthesia in geriatric patients undergoing hip fracture surgery?
Regional and general anesthesia have comparable mortality outcomes in geriatric hip fracture surgery, but peripheral nerve blocks improve early pain management.
The rising incidence of hip fractures in aging populations necessitates optimized perioperative management to mitigate complications. This narrative review evaluates the impact of regional anesthesia (RA) and analgesia techniques compared to general anesthesia (GA) on perioperative outcomes in geriatric patients undergoing hip fracture surgery. Current evidence reveals no consistent mortality benefit for RA over GA. Multicenter trials such as REGAIN and RAGA found no significant difference in 30‐ to 60‐day survival. Similarly, spinal anesthesia does not show a clear superior advantage over GA on postoperative delirium (POD) in geriatric hip fracture patients. For pneumonia and other major complications, current evidence remains inconclusive, with more well‐designed studies needed in the future. Peripheral nerve blocks (PNBs), including femoral block, fascia iliaca compartment block, and pericapsular nerve group blocks, demonstrate superior perioperative analgesia by reducing opioid consumption and early pain scores. However, evidence on PNBs’ effects on mortality or major complications remains limited. Overall, RA and GA exhibit comparable mortality outcomes, while PNBs enhance pain management but require further high‐quality trials to assess long‐term benefits. Current data highlight the need for individualized anesthesia strategies and robust RCTs to clarify optimal practices in high‐risk geriatric populations.
Tao et al. (Thu,) realizaron una revisión sobre fractura de cadera. Se evaluó la anestesia regional (AR) y los bloqueos de nervios periféricos (BNP) en comparación con la anestesia general (AG) sobre los resultados perioperatorios que incluyen mortalidad y delirium postoperatorio. La anestesia regional no mostró un beneficio consistente en mortalidad o delirium postoperatorio en pacientes geriátricos con fracturas de cadera, aunque los bloqueos de nervios periféricos mejoraron la analgesia.