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Tytuł:
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Impact of multiple nerves blocks anaesthesia on intraoperative hypotension and mortality in hip fracture surgery intermediate-risk elderly patients: A propensity score-matched comparison with spinal and general anaesthesia.
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Autorzy:
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Mounet B; Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France.
Choquet O; Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France.
Swisser F; Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France.
Biboulet P; Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France.
Bernard N; Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France.
Bringuier S; Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France; Department of Medical Statistics, and Epidemiology, Montpellier University Hospital, 34295 Montpellier Cedex 5, France.
Capdevila X; Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France; Inserm Unit 1298 Montpellier NeuroSciences Institute, Montpellier University, 34295 Montpellier Cedex 5, France. Electronic address: .
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Źródło:
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Anaesthesia, critical care & pain medicine [Anaesth Crit Care Pain Med] 2021 Aug; Vol. 40 (4), pp. 100924. Date of Electronic Publication: 2021 Jul 01.
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Typ publikacji:
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Clinical Trial; Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: Issy-les-Moulineaux cedex, France : Published by Elsevier Masson SAS on behalf of the Société française d'anesthésie et de réanimation (Sfar), [2015]-
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MeSH Terms:
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Anesthesia, Spinal*/adverse effects
Hip Fractures*/surgery
Hypotension*/epidemiology
Aged ; Anesthesia, General/adverse effects ; Humans ; Propensity Score
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Contributed Indexing:
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Keywords: Continuous spinal block; Frail patients; Hip fracture; Hypotension; Lumbo-sacral plexus block; Mortality
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Molecular Sequence:
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ClinicalTrials.gov NCT03356704
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Entry Date(s):
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Date Created: 20210704 Date Completed: 20210929 Latest Revision: 20220531
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Update Code:
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20240105
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DOI:
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10.1016/j.accpm.2021.100924
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PMID:
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34217841
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Background: A Hip fracture in the intermediate-risk elderly patient is common and associated with a high rate of postoperative morbidity and mortality. There is a lack of consensus on the optimal anaesthetic technique but there is a clear association between intraoperative hypotension and postoperative morbidity and mortality. We aimed to compare the haemodynamic stability of three anaesthesia techniques: general anaesthesia (GA), continuous spinal anaesthesia (CSA), and multiple nerve blocks (MNB).
Methods: The primary outcome was the occurrence of intraoperative hypotension defined by a 30% decrease in mean arterial pressure (MAP) from baseline. Secondary outcomes included incidence of hypotension under 50 mmHg of MAP, time spent below MAP 50 mmHg, use of vasopressors, in-hospital and 30-day mortality. A propensity score-matched analysis was performed.
Results: After screening and application of the exclusion criteria, 593 patients undergoing hip fracture surgery between the 1 st of January 2015 and the 31 st of December 2016 were included. The propensity score match analysis selected 43 patients in each group. The incidence of hypotension was significantly higher in the GA group than in the MNB and CSA groups: 39 (90%), 22 (51%), and 23 (53.5%), respectively; p < 0.0001. The incidence of MAP < 50 mmHg (59.5%, 23.3%, and 16.3%; p < 0.0001) and the use of vasopressors (93%, 39.5%, and 25.6%; p < 0.0001) were increased significantly in the GA group. With the GA group as a reference, odds ratios were reported in the MNB group at 0.08 [0.022-0.30] (p = 0.0002) for hypotension episodes; 0.17 [0.04-0.66] (p = 0.01) for hypotension < 50 mmHg for more than 3 min and 0.049 [0.013-0.018] (p < 0.0001) for use of vasopressors. The duration of hospital stay, postoperative complications, in-hospital and 30-day mortality rates did not differ significantly between the groups.
Conclusion: CSA and MNB provide better haemodynamic stability than GA. However, whatever the anaesthesia technique used, the mortality rates do not change even if MNB leads to less hypotension. IRB contact information: CERAR IRB 00010254-2016-118. Clinical Trial Number: ClinicalTrials.gov. ID: NCT03356704.
(Copyright © 2021 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)
