Hip fractures are a common injury, especially among the elderly population. According to the CDC, over 300,000 individuals aged 65 and older were hospitalized for hip fractures in 2017 in the United States.

The management of hip fractures involves a combination of surgical intervention, pain management, and rehabilitation. One important decision that must be made is whether to use general anesthesia or regional anesthesia during the surgical procedure.

General Anesthesia

General anesthesia involves the administration of medications to induce a reversible loss of consciousness. The anesthesiologist closely monitors the patient’s vital signs and maintains a patent airway throughout the procedure.

General anesthesia is typically used for longer and more complex surgical procedures.

When it comes to hip fracture surgery, general anesthesia is preferred when the patient has significant comorbidities or when the surgical procedure is anticipated to be lengthy.

Additionally, general anesthesia may be preferable in patients with cognitive impairment who may have difficulty following instructions during the procedure.

Regional Anesthesia

Regional anesthesia involves the administration of a local anesthetic to numb a specific region of the body. The two most commonly used types of regional anesthesia for hip fractures are spinal anesthesia and femoral nerve block.

Spinal anesthesia involves the injection of a local anesthetic into the spinal canal, which results in a loss of sensation and motor function in the lower extremities.

A femoral nerve block involves the injection of a local anesthetic around the femoral nerve, which provides anesthesia to the region around the hip and knee.

Regional anesthesia has become increasingly popular in recent years due to its many benefits. Regional anesthesia can reduce pain after surgery, decrease the need for opioids, and reduce the risk of postoperative delirium.

Additionally, regional anesthesia can be used in patients who are unable to tolerate general anesthesia due to comorbidities.

Comparison of General vs. Regional Anesthesia for Hip Fracture Surgery

Multiple studies have compared the use of general anesthesia and regional anesthesia for hip fracture surgery. Overall, the evidence suggests that regional anesthesia is associated with improved outcomes when compared to general anesthesia.

A meta-analysis published in the Journal of the American Medical Association in 2014 found that regional anesthesia was associated with a lower risk of mortality, pulmonary complications, and delirium when compared to general anesthesia.

Additionally, patients who received regional anesthesia had shorter hospital stays and required fewer opioids for postoperative pain management.

A more recent study published in the Journal of Clinical Anesthesia in 2020 found similar results. The study compared the outcomes of patients who received spinal anesthesia to those who received general anesthesia for hip fracture surgery.

The patients who received spinal anesthesia had a shorter length of stay, a lower incidence of delirium, and a lower incidence of urinary retention when compared to the general anesthesia group.

Conclusion

When it comes to hip fracture surgery, the evidence suggests that regional anesthesia is associated with improved outcomes when compared to general anesthesia.

Regional anesthesia can reduce pain, decrease the need for opioids, and reduce the risk of postoperative delirium. Additionally, regional anesthesia can be used in patients who are unable to tolerate general anesthesia due to comorbidities.

However, it is important to note that each patient is unique, and the decision to use general anesthesia or regional anesthesia should be made on a case-by-case basis.

Factors such as the patient’s comorbidities, the length of the surgical procedure, and the patient’s preferences should all be taken into consideration.