Clinical trial NCT03356704: Combined Plexus Block for Hip Fracture 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.
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Hip Fractures
Keywords: adults
Lead sponsor: University Hospital, Montpellier
Sponsor class: OTHER
First posted: 2017-11-29
Enrollment: 593
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: All adults patients operated for hip fracture between 1 January 2015 and 31 December 2016.

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.

Eligibility criteria: Inclusion criteria:

* Adult
* Hip fracture surgery

Exclusion criteria:

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

Primary outcomes:
measure: Intraoperative hypotension
timeFrame: 1 day
Secondary outcomes:
measure: measure the total consumption of the vasopressive molecules
timeFrame: 1 day
measure: Length of stay
timeFrame: 1 day
measure: compare the use of emergency antalgics
timeFrame: 1 day
measure: Inhospital mortality
timeFrame: 1 day
Other outcomes:
Locations:
Study officials:
affiliation: University Hospital, Montpellier
name: Xavier Capdevila, MD, PhD
role: STUDY_DIRECTOR
References:
citation: 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.