Application of Unilateral Epidural Anesthesia in Older Patients With Hip Fracture
Study Details
Study Description
Brief Summary
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.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Detailed Description
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.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| unilateral epidural anesthesia (UEA) group 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
The patients received unilateral epidural anesthesia
|
| combined lumbar and epidural anesthesia (CSEA) group 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
The patients received combined lumbar and epidural anesthesia
|
Outcome Measures
Primary Outcome Measures
- Hemodynamic change [Within 5 minutes after anesthesia]
Heart rate
- Hemodynamic change [Within 5 minutes after anesthesia]
Oxygen saturation
- Hemodynamic change [Within 10 minutes after anesthesia]
Heart rate
- Hemodynamic change [Within 10 minutes after anesthesia]
Oxygen saturation
- Hemodynamic change [Within 15 minutes after anesthesia]
Heart rate
- Hemodynamic change [Within 15 minutes after anesthesia]
Oxygen saturation
- Hemodynamic change [Within 20 minutes after anesthesia]
Heart rate
- Hemodynamic change [Within 20 minutes after anesthesia]
Oxygen saturation
Secondary Outcome Measures
- Dose of ephedrine use [During the surgery period]
Recoded dose of ephedrine use
Other Outcome Measures
- Duration of hospital stay [During the surgery period]
Recoded duration of hospital stay
- Mortality [Perioperative period]
Mortality
- Lower limb function [One year later]
Lower limb function (Harris score)
Eligibility Criteria
Criteria
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.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Sichuan Provincial People's Hospital | Chengdu | Sichuan | China | 610072 |
Sponsors and Collaborators
- Sichuan Provincial People's Hospital
Investigators
- Principal Investigator: Overall Study Officials Zhao, M.D., Sichuan Provincial People's Hospital
Study Documents (Full-Text)
None provided.More Information
Publications
- Bentler SE, Liu L, Obrizan M, Cook EA, Wright KB, Geweke JF, Chrischilles EA, Pavlik CE, Wallace RB, Ohsfeldt RL, Jones MP, Rosenthal GE, Wolinsky FD. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol. 2009 Nov 15;170(10):1290-9. doi: 10.1093/aje/kwp266. Epub 2009 Oct 4.
- Cheng SY, Levy AR, Lefaivre KA, Guy P, Kuramoto L, Sobolev B. Geographic trends in incidence of hip fractures: a comprehensive literature review. Osteoporos Int. 2011 Oct;22(10):2575-86. doi: 10.1007/s00198-011-1596-z. Epub 2011 Apr 12.
- Prestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, Lydersen S, Halsteinli V, Saltnes T, Lamb SE, Johnsen LG, Saltvedt I. Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet. 2015 Apr 25;385(9978):1623-33. doi: 10.1016/S0140-6736(14)62409-0. Epub 2015 Feb 5.
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