The selection of best anesthesiological technique for hip fracture surgery in older high-risk patients

Radić, Nevenka; Radinovic, Kristina; Ille, Mihailo; Lešić, Aleksandar; Ljubičić-Stojanović, Mirjana; Bumbaširević, Marko

doi:10.2298/aci1203113r

Cited by 3 publications

(3 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several studies demonstrated that compared with general anesthesia, neuraxial anesthesia has some advantages such as airway management avoidance, no intubation requirement, and prolonged postoperative analgesia [4]. Furthermore, neuraxial anesthesia could decrease blood loss, potentially reduce risk of postoperative nausea and vomitting (PONV), as well as deep venous thrombosis [4][5][6]. Conversely, general anesthesia is reported to provide a more stable hemodynamic state, faster induction, and avoid some complications such as pneumonia, epidural haematoma and infection [7,8].…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy of Neuraxial and general anesthesia for hip fracture surgery: a meta-analysis of randomized clinical trials

et al. 2020

View full text Add to dashboard Cite

Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery. Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. Sensitivity analyses were conducted using a Bonferroni correction and the leave-one-out method. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The outcomes for the meta-analysis showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = − 0.65, 95% CI-0.32, 0.02; P = 0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia, and there was a significant difference in blood loss between the two groups (MD = − 137.8, 95% CI-241.49, − 34.12; p = 0.009). However, after applying the Bonferroni correction for multiple testing, all the adjusted p-values were above the significant threshold of 0.05. The evidence quality for each outcome evaluated by the GRADE system was low. Conclusions: In summary, our present study demonstrated that there might be a difference in blood loss between patients receiving neuraxial and general anaesthesia, however, this analysis was not robust to adjustment for multiple testing and therefore at high risk for a type I error. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue.

show abstract

Section: Introductionmentioning

confidence: 99%

Comparative efficacy of Neuraxial and general anesthesia for hip fracture surgery: a meta-analysis of randomized clinical trials

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Several studies demonstrated that compared with general anesthesia, neuraxial anesthesia has some advantages such as airway management avoidance, no intubation requirement, and prolonged postoperative analgesia 4 . Furthermore, neuraxial anesthesia could provide excellent intraoperative anesthesia, decrease blood loss, potentially reduce risk of postoperative nausea and vomitting (PONV), as well as deep venous thrombosis [4][5][6] . Conversely, general anesthesia is reported to provide a more stable hemodynamic state, faster induction, and avoid some complications such as pneumonia, epidural haematoma and infection 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

Zheng

Tang

Gao

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery. Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were performed by the leave-one-out approach. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The results showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = -0.65, 95% CI -0.32, 0.02; P =0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia. There was a significant difference in terms of blood loss in favor of the neuraxial anesthesia (MD = -137.8, 95% CI -241.49, -34.12; p = 0.009). The evidence quality for each outcome evaluated by the GRADE system was low. Conclusions: In summary, our present study demonstrated that neuraxial anesthesia is associated with a reduced blood loss in patients undergoing hip fracture surgery compared to general anesthesia. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue.

show abstract

“…Several studies demonstrated that compared with general anesthesia, neuraxial anesthesia has some advantages such as airway management avoidance, no intubation requirement, and prolonged postoperative analgesia 4 . Furthermore, neuraxial anesthesia could provide excellent intraoperative anesthesia, decrease blood loss, potentially reduce risk of postoperative nausea and vomitting (PONV), as well as deep venous thrombosis [4][5][6] . Conversely, general anesthesia is reported to provide a more stable hemodynamic state, faster induction, and avoid some complications such as pneumonia, epidural haematoma and infection 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

Zheng

Tang

Gao

et al. 2019

Preprint

View full text Add to dashboard Cite

Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery. Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were performed by the leave-one-out approach. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The results showed that there were no significant differences in the 30-day mortality, length of stay, and the prevalence of delirium, acute myocardial infarction, and pneumonia for neuraxial anesthesia compared to general anesthesia. There was a significant difference in terms of blood loss in favor of the neuraxial anesthesia. The evidence quality for each outcome evaluated by the GRADE system was low. Conclusions: In summary, our present study demonstrated that neuraxial anesthesia is significantly superior to general anesthesia regarding blood loss in patients undergoing hip fracture surgery. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to to clarify this issue.

show abstract

The selection of best anesthesiological technique for hip fracture surgery in older high-risk patients

Abstract: Peripheral nerve blocks are safe and effective anesthesiological technique, which may reduce the mortality in patients with the hip fracture and maintain the hemodynamic stability, both during and after the surgical intervention.

Cited by 3 publications

References 7 publications

Comparative efficacy of Neuraxial and general anesthesia for hip fracture surgery: a meta-analysis of randomized clinical trials

Comparative efficacy of Neuraxial and general anesthesia for hip fracture surgery: a meta-analysis of randomized clinical trials

Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

Contact Info

Product

Resources

About