Application of Unilateral Epidural Anesthesia in Older Patients With Hip Fracture

Study Overview
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Brief Summary
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Because of population ageing, fragility fractures have become a huge burden on healthcare systems and wider society. Fractures result in a sharp drop in both short-term and long-term quality of life, they have a strong influence on activities of daily living and mobility, and they are associated with a significant increase in 1-year mortality (18%-36%). Surgery can benefit elderly patients with hip fractures to an extent, but it entails inevitable risks, particularly with respect to general anesthesia. In recent years unilateral spinal anesthesia has attracted attention due to the advantages of hemodynamic stability, reduced anesthetic dosage, and sufficient sensory block. On the basis of a previous study, in the current study anesthetics were directly implanted into the unilateral epidural space in elderly patients with hip fractures prior to the completion of surgery. Data from 106 patients with old hip fractures who had undergone surgical treatment incorporating unilateral epidural anesthesia (UEA) or combined lumbar and epidural anesthesia were retrospectively analyzed in an attempt to provide a feasible solution for this kind of patients' anesthesia.

Detailed Description
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Surgery can benefit elderly patients with hip fractures to an extent, but it entails inevitable risks, particularly with respect to general anesthesia. In recent years unilateral spinal anesthesia has attracted attention due to the advantages of hemodynamic stability, reduced anesthetic dosage, and sufficient sensory block. On the basis of a previous study, in the current study anesthetics were directly implanted into the unilateral epidural space in elderly patients with hip fractures prior to the completion of surgery.

Official Title
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Application of Unilateral Epidural Anesthesia in Older Patients With Hip Fracture

Conditions
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Spinal Anesthesia

Intervention / Treatment
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* Procedure: unilateral epidural anesthesia
* Procedure: combined lumbar and epidural anesthesia


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: had a fracture of a proximal femur were aged > 65 years the fracture occurred within 2 weeks of receiving treatment with comorbidities including pulmonary disease, arrhythmia, senile valve disease or lacunar infarction underwent intraspinal anesthesia during surgery Exclusion Criteria: had a secondary fracture after endoprosthetic reconstruction or intramedullary nail had a pathological fracture caused by tumor or tuberculosis condition was accompanied by lower limb nerve dysfunction had a cognitive or psychiatric disorder coagulation disorders hospitalization data were incomplete.

Ages Eligible for Study
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Minimum Age: 66 Years
Maximum Age: 94 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| unilateral epidural anesthesia (UEA) group<br>Patients were divided into two groups based on the type of anesthesia they received; a UEA group (n = 42) and a combined spinal epidural anesthesia (CSEA) group (n = 64). | Procedure: unilateral epidural anesthesia<br>* The patients received unilateral epidural anesthesia<br>|
| combined lumbar and epidural anesthesia (CSEA) group<br>Patients were divided into two groups based on the type of anesthesia they received; a UEA group (n = 42) and a combined spinal epidural anesthesia (CSEA) group (n = 64). | Procedure: combined lumbar and epidural anesthesia<br>* The patients received combined lumbar and epidural anesthesia<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hemodynamic change | Heart rate | Within 5 minutes after anesthesia | 
| Hemodynamic change | Oxygen saturation | Within 5 minutes after anesthesia | 
| Hemodynamic change | Heart rate | Within 10 minutes after anesthesia | 
| Hemodynamic change | Oxygen saturation | Within 10 minutes after anesthesia | 
| Hemodynamic change | Heart rate | Within 15 minutes after anesthesia | 
| Hemodynamic change | Oxygen saturation | Within 15 minutes after anesthesia | 
| Hemodynamic change | Heart rate | Within 20 minutes after anesthesia | 
| Hemodynamic change | Oxygen saturation | Within 20 minutes after anesthesia | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dose of ephedrine use | Recoded dose of ephedrine use | During the surgery period | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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unilateral epidural anesthesia, combined lumbar and epidural anesthesia