2024, Vol. 7, Issue 3, Part B

Background: Fracture femur (Hip fracture) is one of the commonest fracture in elderly. These patients have associated comorbidities due to aging. Hence providing anaesthesia presents a challenge in terms of maintaining hemodynamic stability and optimal functions of brain, heart, lungs and kidneys.

Various techniques of anaesthesia are used at our institution for proximal femur fracture, like Subarachnoid block (SAB), Combined Spinal and Epidural anaesthesia (CSE), Continous Spinal Anaesthesia (CSA), General anaesthesia (GA) and Lumbar plexus block + Sciatic block (LPB+ SCB). We studied factors affecting choice of anaesthesia and corelation between type of anaesthesia and intraoperative stable hemodynamics or adverse events.

Methods: Post ethics committee approval, data such as demographic details of patients, surgery details, ASA grading and associated comorbidities, of patients of age18 years and above, operated for proximal femur fracture in our institution from January 2020 to January 2022, was analyzed to study whether choice of anaesthesia varied according to age, type of comorbidities, general condition of patient (ASA grading). We checked for any adverse events intraoperatively and whether choice of anaesthesia affected this outcome.

Results: The study included 54.5% females and 45.5% males; most common age group observed was 70 years and above (57.04 %). Most common anaesthesia administered was SAB, though its use decreased with increase in perioperative risk. 61.76% of ASA I patients, 60.20 % of ASA II patients and 50% of ASA III patients received SAB. Use of CSA, LPB+ SCB and GA was seen more in patients of 60 years and above. Out of 24 ASA III patients, 21 (87.5%) received regional anaesthesia compared to 3 (12.5%) receiving general anaesthesia. CSE was preferred followed by GA for patients with multiple comorbidities.

Conclusion: Choice of anaesthesia for proximal fracture femur did depend on age, ASA grading (functional status) and comorbidities.