From the Duke University School of Medicine, Durham, NC (Morriss, Kim, MacAlpine, LaRose, Wixted, and Adu-Kwarteng), the Department of Orthopaedic Surgery, Duke University, Durham, NC (Kerr, Cunningham, DeBaun, and Gage).
J Am Acad Orthop Surg. 2023 Jun 15;31(12):641-649. doi: 10.5435/JAAOS-D-22-00277.
Peripheral nerve blocks (PNB) has been increasingly used in the care of patients with geriatric hip fracture to reduce perioperative opiate use and the need for general anesthesia. However, the associated motor palsy may impair patients' ability to mobilize effectively after surgery and subsequently may increase latency to key mobility milestones postoperatively, as well as increase inpatient length of stay (LOS). The aim of this study was to investigate time-to-mobility milestones and length of hospital stay between peripheral, epidural, and general anesthesia.
A retrospective review identified 1,351 patients aged 65 years or older who underwent surgery for hip fracture between 2012 and 2018 at a single academic health system. Patients were excluded if baseline nonambulatory, restricted weight-bearing postoperatively, or sustained concomitant injuries precluding mobilization, with a final cohort of 1,013 patients. Time-to-event analyses for discharge and mobility milestones were assessed using univariate Kaplan-Meier and multivariate Cox proportional hazard regression analyses.
PNB was associated with delayed postoperative time to ambulation ( P < 0.001) and time to out-of-bed ( P = 0.029), along with increased LOS ( P < 0.001). Epidural anesthesia was associated with less delay to first out-of-bed ( P = 0.002), less delay to ambulation ( P = 0.001), and overall reduced length of stay ( P < 0.001).
PNB was associated with slower mobilization and longer hospitalization while epidural anesthesia was associated with quicker mobilization and shorter hospital stays. Epidural anesthesia may be a preferable anesthesia choice in patients with geriatric hip fracture when possible.
Level III.
外周神经阻滞（PNB）已越来越多地应用于老年髋部骨折患者的治疗中，以减少围手术期阿片类药物的使用和全身麻醉的需求。然而，相关的运动神经麻痹可能会影响患者术后的有效活动能力，从而可能延迟术后关键活动里程碑的实现，并增加术后住院时间（LOS）。本研究旨在探讨外周神经阻滞、硬膜外麻醉和全身麻醉之间在实现活动里程碑和住院时间方面的差异。
本回顾性研究纳入了 2012 年至 2018 年期间在单一学术医疗系统接受髋部骨折手术的 1351 例年龄在 65 岁及以上的患者。排除基线时无法活动、术后限制负重或因合并损伤而无法活动的患者，最终纳入了 1013 例患者。采用单变量 Kaplan-Meier 和多变量 Cox 比例风险回归分析评估出院和活动里程碑的时间。
PNB 与术后活动（ P < 0.001）和离床（ P = 0.029）时间延迟以及 LOS 增加（ P < 0.001）相关。硬膜外麻醉与首次离床时间延迟减少（ P = 0.002）、活动时间延迟减少（ P = 0.001）和总住院时间缩短（ P < 0.001）相关。
PNB 与活动和住院时间延长相关，而硬膜外麻醉与更快的活动和更短的住院时间相关。在可能的情况下，硬膜外麻醉可能是老年髋部骨折患者更理想的麻醉选择。
III 级。
