Effect of various anesthesia methods on surgical treatment outcomes in patients with proximal femur fracture: a narrative review

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

Fractures of the proximal femur (FPF) is an unclassified condition that involves fractures of the femoral head and femoral neck and transvertebral, intervertebral, and subvertebral femoral fractures. To date, the number of patients with FPF in Russia is continuously increasing. Most often, patients with FPF have several concomitant diseases that can have a noticeable effect on the choice of anesthesia method. This review aimed to analyze current literature data on the advantages, risks, and contraindications of traditional and novel approaches to anesthesia in surgeries for FPF and assess the impact of these approaches on postoperative outcomes. A search for publications in the electronic databases PubMed and eLibrary was conducted. It revealed 6 324 publications in PubMed and 520 in eLibrary. After selecting publications, 60 studies meeting the inclusion criteria were included in the review. Studies have shown that regional blockades are highly effective; however, the evidence requires additional confirmation. New local anesthesia methods, such as MAC-STILA, can reduce mortality, especially in patients with a burdened medical history. Although the results of the single-center pilot studies of MAC-STILA are promising, multicenter randomized trials are required to test the reproducibility of this approach and evaluate its effectiveness with respect to outcomes that are crucial for the elderly and their family members.

About the authors

Darya S. Teterina

Rostov State Medical University

Author for correspondence.
Email: secretplace@internet.ru
ORCID iD: 0009-0009-8963-9276
SPIN-code: 7755-9127

department assistant

Russian Federation, Rostov-on-Don

Valeria M. Silantyeva

Rostov State Medical University

Email: lerka2001sil@mail.ru
ORCID iD: 0009-0008-5806-0723

medical resident

Russian Federation, Rostov-on-Don

Ansel R. Sakhibullin

Kazan State Medical University

Email: sakhibullin.ansel@gmail.com
ORCID iD: 0009-0008-8702-5986

department assistant

Russian Federation, Kazan

Dmitriy S. Petrov

Georgievsky Order of the Red Banner of Labor Medical Institute

Email: Petroff1810@mail.ru
ORCID iD: 0009-0009-0031-1419
SPIN-code: 2793-9630

student

Russian Federation, Simferopol

Anna O. Dymkova

Voino-Yasenetsky Krasnoyarsk State Medical University

Email: dyimkova2000@list.ru
ORCID iD: 0009-0008-1957-7519

student

Russian Federation, Krasnoyarsk

Muhammed R. Medzhidov

Rostov State Medical University

Email: medzhidov012001@yandex.ru
ORCID iD: 0000-0002-2024-6505
SPIN-code: 4041-2171

student

Russian Federation, Rostov-on-Don

Yulia M. Korneeva

Smolensk State Medical University

Email: cool.urda@yandex.ru
ORCID iD: 0009-0009-8406-9200
SPIN-code: 7024-9353

student

Russian Federation, Smolensk

Yana A. Khachaturova

Samara State Medical University

Email: hacaturovaana3@gmail.com
ORCID iD: 0009-0002-4701-4912
SPIN-code: 5218-8949

student

Russian Federation, Samara

Sofia M. Menyailo

Astrakhan State Medical University

Email: sofiameniailo@yandex.ru
ORCID iD: 0009-0000-3563-8432
SPIN-code: 7635-4745

student

Russian Federation, Astrakhan

Ksenia I. Abramova

Georgievsky Order of the Red Banner of Labor Medical Institute

Email: ksuha4258@gmail.com
ORCID iD: 0000-0002-3535-6870
SPIN-code: 4687-0813

student

Russian Federation, Simferopol

Bakhrombek U. Babaev

Russian University of Medicine

Email: babaevbaha97@gmail.com
ORCID iD: 0009-0006-8360-3481

student

Russian Federation, Moscow

Yulia S. Bychenkova

Stavropol State Medical University

Email: y.bychenkova_2001@mail.ru
ORCID iD: 0009-0002-4625-181X

student

Russian Federation, Stavropol

Valeriya V. Chzhan-Zou-Min

Mechnikov Northwestern State Medical University

Email: valeeryyy1999@gmail.com
ORCID iD: 0009-0004-6821-4571

student

Russian Federation, St. Petersburg

Olga S. Grabko

Mechnikov Northwestern State Medical University

Email: grabko-olya@mail.ru
ORCID iD: 0009-0005-3774-5238
SPIN-code: 1390-0475

student

Russian Federation, St. Petersburg

References

  1. Dubrov VE, Shelupaev AA, Arutynov GP, et al. Fractures of the proximal femur. Clinical features, diagnosis and treatment (Clinical guidelines, abridged version). N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(4):49−89. doi: 10.17816/vto100763
  2. Seryapina YuV, Fedyaev DV, Musina NZ. Incidence of fractures of the proximal femur in patients aged 60 years and older in the Russian Federation. Medical Technologies. Assessment and Choice. 2020;(2):59–66. doi: 10.17116/medtech20204002159
  3. Eremin IK, Daniliyants AA, Zagorodniy NV. Comparative evaluation of the clinical efffcacy and safety of surgical approaches in total hip arthroplasty. Genij Ortopedii. 2023;29(4):438–448. doi: 10.18019/1028-4427-2023-29-4-438-448
  4. Arefieva MS, Eruslanova KA, Runikhina NK, et al. Rehabilitation Programs for Older Surgical Patients in the Postoperative Period. Russian Journal of Geriatric Medicine. 2023;16(4):261–272. doi: 10.37586/2686-8636-4-2023-261-272
  5. Das S, Ghosh S. Monitored anesthesia care: an overview. J Anaesthesiol Clin Pharmacol. 2015;31(1):27. doi: 10.4103/0970-9185.150525
  6. Fain AM, Yarygin NV, Gnetetskii SF, et al. Features of surgical tactics in the treatment of proximal femur fractures in geriatric patients. Practical medicine. 2022;20(4):117–122. doi: 10.32000/2072-1757-2022-4-117-122
  7. Konda SR, Ranson RA, Dedhia N, et al. Monitored anesthesia care and soft-tissue infiltration with local anesthesia: an anesthetic option for high-risk patients with hip fractures. J Orthop Trauma. 2021;35(10):542–549. doi: 10.7759/cureus.20624
  8. Testa EJ, Albright AJ, Morrissey P, et al. Local anesthetic with monitored anesthesia care in cephalomedullary nailing of proximal femur fractures. Orthopaedics & Traumatology: Surgery & Research. 2023;109:103619 doi: 10.1016/j.otsr.2023.103619
  9. Sokolova MM, Kirov MY, Shelygin KV. Postoperative delirium: modern aspects of diagnosis, prevention and therapy. Kuban Scientific Medical Bulletin. 2018;25(6):184–191. doi: 10.25207/1608-6228-2018-25-6-184-191
  10. Haynes MS, Alder KD, Toombs C, et al. Predictors and sequelae of postoperative delirium in a geriatric patient population with hip fracture. JAAOS Global Research & Reviews. 2021;5(5):20.00221. doi: 10.5435/JAAOSGlobal-D-20-00221
  11. Maxwell BG, Spitz W, Porter J. Association of increasing use of spinal anesthesia in hip fracture repair with treating an aging patient population. JAMA Surg. 2020;155(2):167–168. doi: 10.1001/jamasurg.2019.4471
  12. Tsikas D, Jordan J, Engeli S. Blood pressure-lowering effects of propofol or sevoflurane anaesthesia are not due to enhanced nitric oxide formation or bioavailability. Br J Clin Pharmacol. 2015;79(6):1030. doi: 10.1111/bcp.12568
  13. Politov ME, Panov NV, Ovechkin AM, Sokologorsky SV. The effect of the method of anesthesia and analgesia on the formation of chronic pain syndrome in patients who underwent total knee or hip replacement. Ann Crit Care. 2020;(1):25–32. doi: 10.21320/1818-474X-2020-1-25-32
  14. Koriachkin VA, Zabolotski DV, Kuzmin VV, et al. Anaesthesia for hip fracture surgery in geriatric patients (clinical guidelines). Regional Anesthesia and Acute Pain Management. 2017;11(2):133–142. doi: 10.17816/RA42873
  15. Akhtyamov IF, Safin RR, Han HH. Issues of anesthesiological care for patients with fractures of the proximal femur. Politrauma. 2018;(2):93–99. EDN: XSLSWD
  16. Olawin AM, M Das J. Spinal Anesthesia. 2022 Jun 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537299/
  17. Neuman MD, Silber JH, Elkassabany NM, et al.. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology. 2012;117(1):72–92. doi: 10.1097/ALN.0b013e3182545e7c
  18. Ahn EJ, Kim HJ, Kim KW, et al. Comparison of general anaesthesia and regional anaesthesia in terms of mortality and complications in elderly patients with hip fracture: a nationwide population-based study. BMJ Open. 2019;9(9):e029245. doi: 10.1136/bmjopen-2019-029245
  19. Ravi B, Pincus D, Choi S, et al. Association of Duration of Surgery With Postoperative Delirium Among Patients Receiving Hip Fracture Repair. JAMA Netw Open. 2019;2(2):e190111. doi: 10.1001/jamanetworkopen.2019.0111
  20. Chu CC, Weng SF, Chen KT, et al. Propensity Score-matched Comparison of Postoperative Adverse Outcomes between Geriatric Patients Given a General or a Neuraxial Anesthetic for Hip Surgery: A Population-based Study. Anesthesiology. 2015;123(1):136–147. doi: 10.1097/ALN.0000000000000695
  21. Neuman MD, Rosenbaum PR, Ludwig JM, et al. Anesthesia technique, mortality, and length of stay after hip fracture surgery. JAMA. 2014;311(24):2508–2517. doi: 10.1001/jama.2014.6499
  22. Chen DX, Yang L, Ding L, et al. Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis. Medicine. 2019;98(49):18220. doi: 10.1097/MD.0000000000018220
  23. Zheng X, Tan Y, Gao Y, Liu Z. Comparative efficacy of Neuraxial and general anesthesia for hip fracture surgery: a meta-analysis of randomized clinical trials. BMC Anesthesiol. 2020;20(1):162. doi: 10.1186/s12871-020-01074-y
  24. Neuman MD, Feng R, Carson JL, et al. REGAIN Investigators. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. N Engl J Med. 2021;385(22):2025–2035. doi: 10.1056/NEJMoa2113514
  25. Neuman MD, Feng R, Ellenberg SS, et al. REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) Investigators. Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery : A Randomized Clinical Trial. Ann Intern Med. 2022;175(7):952–960. doi: 10.7326/M22-0320
  26. Simonin M, Delsuc C, Meuret P, et al. Hypobaric Unilateral Spinal Anesthesia Versus General Anesthesia for Hip Fracture Surgery in the Elderly: A Randomized Controlled Trial. Anesth Analg. 2022;135(6):1262–1270. doi: 10.1213/ANE.0000000000006208
  27. Wang H, Gao L. Association between general anesthesia and the occurrence of cerebrovascular accidents in hip fracture patients. J Health Eng. 2021;2021:7. doi: 10.1155/2021/72711
  28. O’Connor MI, Switzer JA. AAOS Clinical Practice Guideline Summary: Management of Hip Fractures in Older Adults. J Am Ac xad Orthopx Surg. 2022;30(20):1291-1296. doi: 10.5435/JAAOS-D-22-00125
  29. Morozov DV, Koriachkin VA. Recommendations for anesthesia management of hip and hip surgery: literature review. Regional Anesthesia and Acute Pain Management. 2023;17(2):81–88. doi: 10.17816/RA191375
  30. Tsai TY, Cheong KM, Su YC, et al.. Ultrasound-guided femoral nerve block in geriatric patients with hip fracture in the emergency department. J Clin Med. 2022;11(10):2778. doi: 10.3390/jcm11102778
  31. Uysal Aİ, Altıparmak B, Yaşar E, et al. The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial. Ulus Travma Acil Cerrahi Derg. 2020;26(1):109–114. doi: 10.14744/tjtes.2019.78002.
  32. Guay J, Parker MJ, Griffiths R, Kopp SL. Peripheral Nerve Blocks for Hip Fractures: A Cochrane Review. Anesth Analg. 2018;126(5):1695–1704. doi: 10.1213/ANE.0000000000002489
  33. Skjold C, Møller AM, Wildgaard K. Pre-operative femoral nerve block for hip fracture-A systematic review with meta-analysis. Acta Anaesthesiol Scand. 2020;64(1):23–33. doi: 10.1111/aas.13491
  34. Gates M, Pillay J, Nuspl M, et al. Screening for the primary prevention of fragility fractures among adults aged 40 years and older in primary care: systematic reviews of the effects and acceptability of screening and treatment, and the accuracy of risk prediction tools. Syst Rev. 2023;12(1):51. doi: 10.1186/s13643-023-02181-w
  35. Lim EJ, Koh WU, Kim H, et al. Regional nerve block decreases the incidence of postoperative delirium in elderly hip fracture. J Clin Med. 2021;10(16):3586. doi: 10.3390/jcm10163586
  36. Angers M, Belzile ÉL, Vachon J, et al. Negative Influence of femoral nerve block on quadriceps strength recovery following total knee replacement: A prospective randomized trial. Orthop Traumatol Surg Res. 2019;105(4):633–637. doi: 10.1016/j.otsr.2019.03.002
  37. Diwan S, Nair A, Gawai N, Sancheti P. Flow dynamics of ultrasound-guided lumbar plexus block in adults. J Anaesthesiol Clin Pharmacol. 2021;37(4):565–568. doi: 10.4103/joacp.JOACP_584_20
  38. Winnie A, Ramamurthy S, Durrani Z. The inguinal paravascular technic of lumbar plexus anesthesia: the “3-in-1 block.” Anesth Analg. 1973;52(6):989–996.
  39. Ritter JW. Femoral nerve “sheath” for inguinal paravascular lumbar plexus block is not found in human cadavers. J Clin Anesth. 1995;7(6):470–473.
  40. Piacherski VG, Marachkou AV. The blockade of the sciatic nerve and the posterior femoral cutaneous nerve of subgluteal access «2-in-1 block». Regional Anesthesia and Acute Pain Management. 2017;11(4):257–261. doi: 10.17816/RA42872
  41. Fletcher AK, Rigby AS, Heyes FL. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Ann Emerg Med. 2003;41(2):227–233. doi: 10.1067/mem.2003.51
  42. Marochkov AV. comparative estimation of efficacy of femoral nerve regional blockage and “three in one” blockage. Novosti Khirurgii. 2012;20(6):83–87. EDN: PKINIZ
  43. Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. Am J Emerg Med. 2010. 28(1):76–81. doi: 10.1016/j.ajem.2008.09.015
  44. Verbeek T, Adhikary S, Urman R, Liu H. The application of fascia iliaca compartment block for acute pain control of hip fracture and surgery. Curr Pain Headache Rep. 2021;25(4):22. doi: 10.1007/s11916-021-00940-9
  45. Liang Y, Lv L, He L, et al. A randomized controlled trial of FNB versus FICB for patients with femo-ral neck fractures before spinal anesthesia. Clin Interv Aging. 2020;5:1113–1119. doi: 10.2147/CIA.S251025
  46. Thompson J, Long M, Rogers E, et al. Fascia iliaca block decreases hip fracture postoperative opioid consumption: A prospective randomized controlled trial. J Orthop Trauma. 2020;34(1):49–54. doi: 10.1097/BOT.0000000000001634
  47. Hong HK, Ma Y. The efficacy of fascia iliaca compartment block for pain control after hip fracture: A meta-analysis. Medicine (Baltimore). 2019;98(28):e16157. doi: 10.1097/MD. 0000000000016157
  48. Mouzopoulos G, Vasiliadis G, Lasanianos N, et al. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study. J Orthop Traumatol. 2009;10(3):127–133. doi: 10.1007/s10195-009-0062-6
  49. Girón-Arango L, Peng PWH, Chin KJ, et al. Pericapsular nerve group (PENG) block for hip fracture. Reg Anesth Pain Med. 2018;43(8):859–863. doi: 10.1097/AAP.0000000000000847
  50. Lin DY, Morrison C, Brown B, et al. Pericapsular nerve group (PENG) block provides improved short-term analgesia compared with the femoral nerve block in hip fracture surgery: a single-center double-blinded randomized comparative trial. Reg Anesth Pain Med. 2021;46(5):398–403. doi: 10.1136/rapm-2020-102315
  51. Aliste J, Layera S, Bravo D, et al. Randomized comparison between pericapsular nerve group (PENG) block and suprainguinal fascia iliaca block for total hip arthroplasty. Reg Anesth Pain Med. 2021;46(10):874–878. doi: 10.1136/rapm-2021-102997
  52. Deemer AR, Furgiuele DL, Ganta A, et al. The Lateral Femoral Cutaneous and Over the Hip (LOH) Block for the Surgical Management of Hip Fractures: A Safe and Effective Anesthetic Strategy. J Orthop Trauma. 2023;37(3):135–141. doi: 10.1097/BOT.0000000000002508
  53. Chang A, Dua A, Singh K, et al. Peripheral Nerve Blocks. [Updated 2023 Jul 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459210/
  54. Ihejirika-Lomedico R, Solasz S, Lorentz N, et al. NYU Hip fracture research group. effects of intraoperative local pain cocktail injections on early function and patient-reported outcomes: A randomized controlled trial. J Orthop Trauma. 2023;37(9):433–439. doi: 10.1097/BOT.0000000000002628
  55. Basmajian HG, Liu JN, Farmer TD, et al. Liposomial bupivacaine for postoperative pain control in fragility intertrochanteric hip fractures. J Orthop Trauma. 2020;34(3):139–144. doi: 10.1097/BOT.0000000000001665
  56. Chintalapudi N, Agarwalla A, Bortman J, et al. Liposomal bupivacaine associated with cost savings during postoperative pain management in fragility intertrochanteric Hip fractures. Clin Orthop Surg. 2022;14(2):162–168. doi: 10.4055/cios21024
  57. Sohn HM, Ryu JH. Monitored anesthesia care in and outside the operating room. Korean J Anesthesiol. 2016;69(4):319–326. doi: 10.4097/kjae.2016.69.4.319
  58. Bi AS, Fisher ND, Ganta A, Konda SR. Monitored anesthesia care and soft-tissue infiltration with local anesthesia for short cephalomedullary nailing in medically complex patients: a technique guide. Cureus. 2021;13(12):e20624. doi: 10.7759/cureus.20624
  59. Konda SR, Dedhia N, Rettig S, et al. “Damage control” fixation of displaced femoral neck fractures in high-risk elderly patients: a feasibility case series. J Orthop Trauma. 2021;35(12):e439–e444. doi: 10.1097/BOT.0000000000002104
  60. Sher D, Biant LC. Subcapital fracture of the femoral neck in medically unwell patients: technique for fixation using direct infiltration local anaesthetic rather than regional blockade. Injury. 2007;38(10):1209–1213. doi: 10.1016/j.injury.2007.04.024

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Algorithm for searching researches.

Download (263KB)
Indexing metadata

Copyright (c) 2024 Eco-Vector


 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies