The effect of anesthesia on the risk of postoperative myocardial injury in elderly patients with hip fracture: randomized controlled trial

Abstract

Hip fractures are a common pathology among patients older 50 years and cause disability, reduced duration and quality of life, even with adequate management and surgery. In the perioperative period, the most common complications leading to the death of patients are cardiovascular disease. about a hip fracture.
 The aim of our study was to determine the safest method of anesthesia in the context of acute myocardial injury during hip fracture surgery. The objectives of the study were to determine the frequency of postoperative myocardial damage in patients with hip fractures; compare the frequency of MINS with different types of anesthesia: general anesthesia (GA), spinal anesthesia (SA) and compartment psoas block with sciatic nerve block.
 Materials and methods. Randomized controlled trial was conducted from January 2018 to August 2019 in the medical center “Into-Sana” (Odessa, Ukraine). Patients with planned osteosynthesis of the proximal femur were randomized into 3 groups depending on the method of anesthesia: general anesthesia and postoperative systemic analgesia, spinal anesthesia and postoperative systemic analgesia, prolonged compartment psoas block with sciatic nerve block.
 Results. The study involved 90 patients. Acute postoperative myocardial injury was diagnosed in 17.6 % of cases. Postoperative elevation of troponins was significantly more often diagnosed in groups of patients with spinal anesthesia and general anesthesia compared to the group in which the psoas block compartment was used in combination with the sciatic nerve block. None of the patients had symptoms of myocardial ischemia and were not diagnosed with myocardial infarction. Hypotension was significantly more common in group 2 spinal anesthesia (OR 9 95 % CI 1.9-47, p=0.004) There was a direct moderate association between the intraoperative hypotension and the development of postoperative myocardial injury (r = 0.5).
 Conclusions. Prolonged compartment psoas block with sciatic nerve block intraoperatively is the safest method of anesthesia in the context of the development of postoperative myocardial injury. Intraoperative hypotension is associated with postoperative myocardial injury