Hip Fracture Mortality: Is It Affected by Anesthesia Techniques?

We hypothesized that combined peripheral nerve block (CPNB) technique might reduce mortality in hip fracture patients with the advantage of preserved cardiovascular stability. We retrospectively analyzed 257 hip fracture patients for mortality rates and affecting factors according to general anesthesia (GA), neuraxial block (NB), and CPNB techniques. Patients' gender, age at admission, trauma date, ASA status, delay in surgery, followup period, and Barthel Activities of Daily Living Index were determined. There were no differences between three anesthesia groups regarding to sex, followup, delay in surgery, and Barthel score. NB patients was significantly younger and CPNB patients' ASA status were significantly worse than other groups. Mortality was lower for regional group (NB + CPNB) than GA group. Mortality was increased with age, delay in surgery, and ASA and decreased with CPNB choice; however, it was not correlated with NB choice. Since the patients' age and ASA status cannot be changed, they must be operated immediately. We recommend CPNB technique in high-risk patients to operate them earlier

Effect of Preemptive Femoral Nerve Block on Pain Control and Opioid Consumption After Total Knee Arthroplasty: A Randomized Controlled Trial

Aim: Peripheral nerve blocks, particularly femoral nerve blocks (FNBs), are a practical choice for relieving severe pain after total knee arthroplasty (TKA). We investigated the effectiveness of preemptive FNB on postoperative pain control and the reduction of opioid consumption. Methods: This was a single-center, prospective, randomized controlled trial conducted at a tertiary care health center, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Turkey. The study included 40 American Society of Anesthesiologists I-III patients scheduled for elective TKA surgery. Patients were studied in two groups. The FNB group (n=20) received preemptive single-injection FNB (15 mL of prilocaine 2% and 15 mL of 0.5% bupivacaine using a peripheral nerve stimulator) before general anesthesia (GA) as the study group and the control group (n=20) received standardized GA. The primary outcome measure was pain scores evaluated as numeric pain rating scale (0-10) at 2, 4, 8, 12, 16, 18, 20, and 24 h. Secondary outcome measures included opioid consumption with patient-controlled and perioperative hemodynamic changes. Results: Pain scores and opioid consumption in the FNB group were significantly lower than those in the control group at every measurement time (p<0.05). Total perioperative morphine use was also lower in the FNB group (p=0.023). Regarding hemodynamic variables, the heart rate values at the beginning of surgery and tourniquet insufflation in the FNB group were significantly lower than those in the control group. Conclusion: Using the FNB as part of any multimodal analgesia protocol to alleviate pain after TKA with less analgesic use would be beneficial