Effect of Anesthesia Technique on Outcome After Hip Fracture Surgery in Elderly Adult Patients

Study Overview
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Brief Summary
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Despite many previous studies, whether anesthetic technique will significantly affect overall patient outcome, morbidity and mortality in elderly hip fracture patients is controversial. Due to old age, poor patient condition and emergent clinical settings, patients undergoing surgical procedures for hip fracture management are often subject to poor postoperative outcome and high mortality rates. While many studies have reported that regional anesthesia leads to improved postoperative outcome after hip fracture surgery, others have concluded otherwise. Moreover, because the majority of these previous studies are retrospective cohorts or systemic reviews, there is a need for randomized clinical trials to provide high quality evidence. This study aims to compare patient outcome between three different anesthetic techniques in elderly patients undergoing surgery for hip fracture management by evaluating proinflammatory cytokines, chemistry lab testing and clinical outcome between general anesthesia with either desflurane or propofol-based TIVA and spinal anesthesia with bupivacaine.

Conditions
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Hip Fracture

Intervention / Treatment
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* Drug: Desflurane
* Drug: Propofol
* Drug: Bupivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1. Patients older than 65 years scheduled for elective or emergency hip fracture surgery. Exclusion Criteria: Patient refusal Inflammation or wound at puncture site, increased intracranial pressure, bleeding diathesis Allergies to propofol or its ingredients, soybeans or peanuts Patients with altered mental status Illiterate patients or foreigners

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group D<br>General anesthesia with desflurane | Drug: Desflurane<br>* Inhalation anesthesia with desflurane at age-adjusted MAC of 0.8 1.0<br>|
| Active Comparator: Group P<br>General anesthesia with propofol total intravenous anesthesia | Drug: Propofol<br>* Total intravenous anesthesia with propofol target controlled infusion<br>|
| Active Comparator: Group S<br>Spinal anesthesia with 0.5% bupivacaine | Drug: Bupivacaine<br>* Spinal anesthesia with 0.5% bupivacaine<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| HMGB1 |  | from preoperative baseline to 72hours | 
| IL-6 |  | from preoperative baseline to 72hours | 
| NT-proBNP |  | from preoperative baseline to 72hours | 
| hemoglobin |  | from preoperative baseline to 72hours | 
| total lymphocyte count |  | from preoperative baseline to 72hours | 
| albumin |  | from preoperative baseline to 72hours | 
| creatinine |  | from preoperative baseline to 72hours | 
| potassium |  | from preoperative baseline to 72hours | 
| troponin-T |  | from preoperative baseline to 72hours | 
| CRP |  | from preoperative baseline to 72hours |