Key result
Fascia iliaca block combined with low-dose spinal anaesthesia significantly reduced the incidence of severe intraoperative hypotension compared to general anaesthesia (32.4% vs 67.6%, OR 2.9).
Why the study?
Intraoperative hypotension adversely impacts outcomes in hip fracture surgery, but the comparative incidence between fascia iliaca block with low-dose low-specific-gravity spinal anaesthesia versus general anaesthesia was unclear.
Does fascia iliaca block combined with low-dose low-specific-gravity spinal anaesthesia reduce severe intraoperative hypotension in elderly patients undergoing hip fracture surgery compared to general anaesthesia?
RCT (n=68)
Assessor-blind
Sequentially numbered opaque envelopes
No
Does fascia iliaca block combined with low-dose low-specific-gravity spinal anaesthesia reduce severe intraoperative hypotension in elderly patients undergoing hip fracture surgery compared to general anaesthesia?
Odds Ratio: 2.9 (95% CI 1.4–6)
Absolute Event Rate: 32.4% vs 67.6%
p-value: p=0.004
In elderly patients undergoing hip fracture surgery, combining fascia iliaca block with low-dose low-specific-gravity spinal anaesthesia significantly reduces the incidence of severe intraoperative hypotension and improves postoperative analgesia compared to general anaesthesia.
FIB+LLSA reduces severe hypotension versus GA; supports regional anesthesia preference in elderly hip fracture surgery.
Introduction Hip fractures are increasingly prevalent in ageing populations globally. Surgery is required, necessitating anaesthesia. Intraoperative hypotension adversely impacts outcomes regardless of anaesthetic type. This randomised controlled trial aimed to evaluate severe hypotension incidence with fascia iliaca block (FIB) combined with low-dose, low-specific-gravity spinal anaesthesia (LLSA) versus general anaesthesia (GA) for hip fracture surgery in the elderly. Methods In this single-centre, randomised controlled trial, 68 geriatric hip fracture patients were allocated to receive either FIB + LLSA or GA. The primary outcome was severe hypotension incidence, defined as mean arterial pressure (MAP) < 65 mmHg for > 12 consecutive minutes. Secondary outcomes included vasopressor quantity, pain scores, rescue analgesia requirements, complications, and surgery characteristics. Results Severe hypotension occurred less frequently with FIB + LLSA (32.4%) than GA (67.6%) (OR 2.9; 95% CI 1.4-6.0; P = 0.004). Pain scores, rescue analgesia needs, nausea incidence, and hospital stay were lower with FIB + LLSA (all P < 0.05). No between-group differences occurred in complications or mortality. Conclusion For elderly hip fracture surgery, FIB + LLSA reduced severe hypotension, improved analgesia, and enabled earlier hospital discharge versus GA. FIB + LLSA appears advantageous for this population.
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Zhang et al. (2023) conducted an RCT in Hip fracture (n=68). Fascia iliaca block with low-dose low-specific-gravity spinal anaesthesia (FIB + LLSA) vs. General anaesthesia was evaluated on Incidence of severe hypotension during surgery (MAP < 65 mmHg for > 12 consecutive minutes) (OR 2.9, 95% CI 1.4-6.0, p=0.004). Fascia iliaca block combined with low-dose spinal anaesthesia significantly reduced the incidence of severe intraoperative hypotension compared to general anaesthesia (32.4% vs 67.6%, OR 2.9).
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