Combined Plexus Block for Hip Fracture Surgery.

Is the Combined Plexus Block a Real Alternative for Hip Fracture Surgery in the Elderly? A Comparison With General Anesthesia and Continuous Spinal Anesthesia Using a Propensity Score in a Retrospective Cohort Study.

Hip fracture surgery requires high risk anesthetic procedure for elderly patients (1). General anesthesia, continuous spinal anesthesia and peripheral nerve blocks are three anesthetic techniques possible. Continuous spinal anesthesia has proven its efficacity to provide an intraoperative haemodynamic stability wich guarantees good patients outcomes (2), in comparison with general anesthesia but there is poor evidence in the literature concerning the use of peripheral nerve blocks.

The primary objective of this study was to compare intraoperative haemodynamic stability provides by peripheral nerve block versus general anesthesia and continuous spinal anesthesia.

Secondary outcomes included : use of vasoactive drugs, opioids consumption, lengh of stay and inhospital mortality.

Study Overview

• Status: Completed
• Conditions: Hip Fractures
• Intervention / Treatment: Other: no intervention

Detailed Description

After receiving the ethic approval from the "CERAR", the investigators retrospectively identified all patients who underwent hip fracture surgery from January 1 2015, to December 31, 2016 in the CHU of Montpellier. The exclusion criteria were: multiple trauma victims, two hip fractures in the same patient and single shot spinal anesthesia. In our institution the investigators used to perform three types of anesthesia: general anesthesia (GA), continuous spinal anesthesia (CSA) and combined plexus blocks (CPB). The investigators therefore made three groups GA, CSA and CPB and used a propensity score to make these groups comparable. The matching criteria were age, arterial hypertension, ASA status, Frailty score, chronic cardiac failure and type of surgery.

• Study Type: Observational
• Enrollment (Actual): 593

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

All adults patients operated for hip fracture between 1 January 2015 and 31 December 2016.

Description

Inclusion criteria:

• Adult
• Hip fracture surgery

Exclusion criteria:

• Multiple trauma victims
• Second hip fracture in same patient
• Single shot spinal anesthesia

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Retrospective

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
General anaesthesia; Patient who had surgery for femoral neck fracture from January 2014 to December 2016 and had general anesthesia	Other: no intervention; Observational study
continued spinal anesthesia; Patient who had surgery for femoral neck fracture from January 2014 to December 2016 and had continued spinal anesthesia	Other: no intervention; Observational study
peripheral nerve blocks; Patient who had surgery for femoral neck fracture from January 2014 to December 2016 and had peripheral nerve blocks	Other: no intervention; Observational study

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intraoperative hypotension	Decrease of at least 30% of mean arterial pressure	1 day

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
measure the total consumption of the vasopressive molecules	measure the total consumption of the vasopressive molecules (necessary when the voltage drops by more than 30% compared to the average reference voltage) : Use of vasoactive drugs	1 day
Length of stay	Length of stay	1 day
compare the use of emergency antalgics	compare the use of emergency antalgics : opioids consumption	1 day
Inhospital mortality	Inhospital mortality	1 day

Collaborators and Investigators

• Sponsor: University Hospital, Montpellier
• Investigators: Study Director: Xavier Capdevila, MD, PhD, University Hospital, Montpellier

Publications and helpful links

General Publications

• Mounet B, Choquet O, Swisser F, Biboulet P, Bernard N, Bringuier S, Capdevila X. 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. Anaesth Crit Care Pain Med. 2021 Aug;40(4):100924. doi: 10.1016/j.accpm.2021.100924. Epub 2021 Jul 1.

Study record dates

Study Major Dates

• Study Start (Actual): August 31, 2016
• Primary Completion (Actual): February 1, 2017
• Study Completion (Actual): October 26, 2017

Study Registration Dates

• First Submitted: October 26, 2017
• First Submitted That Met QC Criteria: November 28, 2017
• First Posted (Actual): November 29, 2017

Study Record Updates

• Last Update Posted (Actual): July 19, 2018
• Last Update Submitted That Met QC Criteria: July 17, 2018
• Last Verified: October 1, 2017

More Information

Terms related to this study

• Keywords: adults
• Additional Relevant MeSH Terms: Wounds and Injuries; Leg Injuries; Femoral Fractures; Hip Injuries; Fractures, Bone; Hip Fractures
• Other Study ID Numbers: RECHMPL17_0229

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided
• IPD Plan Description: NC

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No