A novel technique of peripheral nerve blocks and sedation as primary anesthetic technique for adult emergency hip fracture surgery: A retrospective propensity matched study

Background: No study has evaluated peripheral nerve block as the primary anesthetic technique in adult hip fracture surgery. This retrospective cohort study compares peri-operative outcomes between spinal anesthesia and peripheral nerve block with sedation (block-sedation) in adult emergency hip fracture surgery. Methods: Adult patients who underwent hip fracture repair at Fleury Hospital between 2018 and 2025 were screened ( n = 503). Of these, patients receiving planned spinal anesthesia ( n = 238) or block-sedation ( n = 230) were identified. Primary outcome was the success rate of block-sedation in emergency hip fracture surgery, defined as the proportion of patients in whom block-sedation was used without conversion to another anesthetic technique. Secondary outcomes included peri-operative opioid requirement (MME), postoperative pain, intra-operative anesthetic requirements (i.e., ketamine, midazolam, propofol), post-anesthesia care unit (PACU) stay, hospital length of stay, and intra-operative hypotension requiring inotropes. Results: Block-sedation was successful without conversion in 98.1% of patients; four patients (1.9%) required conversion to general anesthesia and were excluded from peri-operative outcomes. Median PACU stay was longer in the spinal group (54 min, IQR 42–72) compared with block-sedation (36 min, IQR 27–53; P < 0.001) The incidence of hypotension requiring inotropes was higher in the spinal group (53.0%) compared with the block-sedation group (19.4%; P < 0.001). Postoperative pain scores were comparable between groups ( P = 0.126), and postoperative hospital length of stay was also similar ( P = 0.416). Conclusion: In this propensity-matched cohort study, block-sedation was feasible and safe for MIS hip fracture surgeries, with a high success rate (>98%) and low conversion to general anesthesia.