Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.
School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.
World J Surg. 2023 Jun;47(6):1444-1456. doi: 10.1007/s00268-023-06949-y. Epub 2023 Feb 24.
Surgery is the preferred treatment option for the elderly patients with hip fractures. However, the choice of general anesthesia (GA) or regional anesthesia (RA) remains controversial. The quality of evidence has further improved with the advent of several high-quality randomized clinical trials (RCTs) in the last two years. The purpose of this study was to compare the clinical outcomes of two anesthetic techniques in elderly patients undergoing hip fracture surgeries.
Eligible studies were identified from PubMed/MEDLINE, Web of Science, Scopus, EMBASE and reference lists from January 2000 to June 2022 in this current systematic review and meta-analysis. The outcomes included the surgery-related outcomes (duration of surgery, duration of anesthesia, intraoperative blood loss and number of transfusions) and postoperative outcomes (30-day mortality, postoperative delirium,cardiovascular events and other complications).
A total of 10 RCTs were included, and a total of 3594 patients were analyzed. RA was associated with shorter duration of surgery, shorter length of hospital stays and less intraoperative blood loss compared to GA. There were no significant differences between the two groups in the number of blood transfusions, duration of anesthesia, 30-day mortality or postoperative delirium.
Our pooled analysis identified no significant differences in terms of the safety between RA and GA, while RA reduces intraoperative blood loss, length of hospital stays and duration of surgery. These results suggest that RA appears to be preferable for the elderly patients with hip fractures.
手术是治疗老年髋部骨折患者的首选治疗方案。然而，全身麻醉（GA）和区域麻醉（RA）的选择仍存在争议。随着过去两年中几项高质量随机临床试验（RCT）的出现，证据质量进一步提高。本研究旨在比较两种麻醉技术在老年髋部骨折手术患者中的临床效果。
本系统评价和荟萃分析从 2000 年 1 月至 2022 年 6 月，通过 PubMed/MEDLINE、Web of Science、Scopus、EMBASE 和参考文献列表，确定了符合条件的研究。结果包括手术相关结果（手术持续时间、麻醉持续时间、术中失血量和输血次数）和术后结果（30 天死亡率、术后谵妄、心血管事件和其他并发症）。
共纳入 10 项 RCT，共分析了 3594 例患者。与 GA 相比，RA 具有手术持续时间更短、住院时间更短和术中失血量更少的优势。两组之间在输血次数、麻醉持续时间、30 天死亡率或术后谵妄方面无显著差异。
我们的荟萃分析发现，RA 和 GA 在安全性方面没有显著差异，而 RA 减少了术中失血量、住院时间和手术持续时间。这些结果表明，RA 似乎更适合老年髋部骨折患者。
