Combined Plexus Block for Hip Fracture Surgery.

Study Overview
=================
Brief Summary
-----------------
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.

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.

Official Title
-----------------
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.

Conditions
-----------------
Hip Fractures

Intervention / Treatment
-----------------
* Other: no intervention


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion criteria: Adult Hip fracture surgery Exclusion criteria: Multiple trauma victims Second hip fracture in same patient Single shot spinal anesthesia

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| General anaesthesia<br>Patient who had surgery for femoral neck fracture from January 2014 to December 2016 and had general anesthesia | Other: no intervention<br>* Observational study<br>|
| continued spinal anesthesia<br>Patient who had surgery for femoral neck fracture from January 2014 to December 2016 and had continued spinal anesthesia | Other: no intervention<br>* Observational study<br>|
| peripheral nerve blocks<br>Patient who had surgery for femoral neck fracture from January 2014 to December 2016 and had peripheral nerve blocks | Other: no intervention<br>* Observational study<br>|

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 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
adults