Key result
Femoral nerve and lateral femoral cutaneous nerve blocks combined with general anesthesia significantly reduced the incidence of intraoperative hypotension (15% vs 71%, p<0.001) compared to lumbar and sacral plexus blocks in elderly patients undergoing hip fracture arthroplasty.
Why the study?
Although lumbar and sacral plexus blocks or femoral and lateral femoral cutaneous nerve blocks with general anesthesia are commonly used for hip fracture arthroplasty, no study had compared these two strategies perioperatively.
Does femoral nerve and LFC nerve block combined with general anesthesia improve intraoperative hemodynamics compared to lumbar and sacral plexus block combined with general anesthesia in elderly patients undergoing arthroplasty for hip fracture?
RCT (n=41)
Single-blind (outcome assessors blinded)
Computer-generated list
No
Does femoral nerve and LFC nerve block combined with general anesthesia improve intraoperative hemodynamics compared to lumbar and sacral plexus block combined with general anesthesia in elderly patients undergoing arthroplasty for hip fracture?
Absolute Event Rate: 15% vs 71%
p-value: p=<0.001
Femoral and lateral femoral cutaneous nerve blocks combined with general anesthesia provide more stable intraoperative hemodynamics with less hypotension compared to lumbar and sacral plexus blocks in elderly patients undergoing hip arthroplasty.
Favors femoral/LFC blocks over lumbar/sacral plexus blocks to minimize hypotension in elderly hip fracture patients; extends RCT evidence for targeted peripheral blockade.
Background Combined 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. Methods A 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. Results Compared 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. Conclusion Our 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.
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Zhang et al. (2022) conducted an RCT in Hip fracture (n=41). Femoral nerve and lateral femoral cutaneous nerve blocks plus general anesthesia vs. Lumbar plexus and sacral plexus blocks plus general anesthesia was evaluated on Incidence of intraoperative hypotension (p=<0.001). Femoral nerve and lateral femoral cutaneous nerve blocks combined with general anesthesia significantly reduced the incidence of intraoperative hypotension (15% vs 71%, p<0.001) compared to lumbar and sacral plexus blocks in elderly patients undergoing hip fracture arthroplasty.
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