Johnston D F, Stafford M, McKinney M, Deyermond R, Dane K
Clinical Fellow Regional Anaesthesia, LHSC, University Hospital, Windermere Road, London, ON, Canada.
Consultant Anaesthetist, The Ulster Hospital, Dundonald, Northern Ireland.
J Clin Anesth. 2016 Mar;29:33-9. doi: 10.1016/j.jclinane.2015.10.012. Epub 2016 Feb 2.
Over the last 6 years, our center has introduced a novel technique combining peripheral nerve blocks (femoral and lateral femoral cutaneous nerves) with sedation using propofol with alfentanil target-controlled infusion for hip fracture surgery. The purpose of this review was to identify if adverse outcomes (of mortality and length of stay) were associated with its introduction compared to spinal or general anesthesia.
Retrospective data collection from hospital fracture database. Data were analyzed using Cox regression (adjusted for age, sex, and American Society of Anesthesiologists grade) to compare survival and length of stay data across the different anesthetic techniques used for hip fracture surgery.
This technique was used in 472 (20%) of 2360 hip fractures. There was no significant difference between peripheral nerve blocks with propofol/alfentanil sedation/analgesia for mortality up to 120days (hazard ratio, 0.76; 95% confidence interval, 0.54-1.06; P=.11) and length of stay (hazard ratio, 1.03; 95% confidence interval, 0.91-1.17; P=.63) when compared to the other anesthetic techniques of spinal and general anesthesia.
This novel technique does not appear to be associated with adverse mortality or length of stay after hip fracture surgery.
在过去6年中，我们中心引入了一种新技术，即将周围神经阻滞（股神经和股外侧皮神经）与使用丙泊酚和阿芬太尼靶控输注镇静相结合，用于髋部骨折手术。本综述的目的是确定与脊髓麻醉或全身麻醉相比，引入该技术是否会导致不良结局（死亡率和住院时间）。
从医院骨折数据库中进行回顾性数据收集。使用Cox回归分析（根据年龄、性别和美国麻醉医师协会分级进行调整）来比较用于髋部骨折手术的不同麻醉技术的生存数据和住院时间数据。
在2360例髋部骨折患者中，有472例（20%）采用了该技术。与脊髓麻醉和全身麻醉等其他麻醉技术相比，丙泊酚/阿芬太尼镇静/镇痛下的周围神经阻滞在120天内的死亡率（风险比，0.76；95%置信区间，0.54 - 1.06；P = 0.11）和住院时间（风险比，1.03；95%置信区间，0.91 - 1.17；P = 0.63）方面无显著差异。
这种新技术似乎与髋部骨折手术后的不良死亡率或住院时间无关。
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