Invest Clin 66(2): 217 - 230, 2025 https://doi.org/10.54817/IC.v66n2a08

Corresponding author. Xinxin Tian. Department of Infectious Diseases, Hangzhou Ninth People’s Hospital.

No. 98 Yilong Road, Yipong Street, Qiantang District, Hangzhou, China. Tel: 86-18317898728.

Email: tianxinxintxxtxx@163.com

Impact of regional anesthesia vs general

anesthesia on postoperative outcomes

in elderly patients with hip fracture:

a meta-analysis.

Feng Han1, Yue Yang1 and Xinxin Tian2

1Department of Anesthesiology, Hangzhou Geriatric Hospital, Hangzhou, China.

2Department of Infectious Diseases, Hangzhou Ninth People’s Hospital, Hangzhou,

China.

Keywords: hip fracture; anesthesia; elderly; meta-analysis.

Abstract. The objective of this study was to utilize meta-analysis to com-

pare the impact of regional anesthesia (RA) versus general anesthesia (GA) on

postoperative outcomes in elderly patients undergoing hip fracture surgery.

Electronic databases (PubMed, Web of Science, Cochrane Library, and Embase)

were searched for randomized controlled trials (RCTs) comparing the effects of

RA and GA in elderly patients undergoing hip fracture surgery. The random or

fixed-effects model was used to calculate pooled relative risks (RR) and mean

differences (MD). Fourteen RCTs involving 5626 elderly patients undergoing

hip fracture surgery were included. Meta-analysis indicated that RA was associ-

ated with a lower incidence of intraoperative blood loss (MD: -39.7 mL; 95% CI:

-68.61, -10.84; p = 0.007), adverse events including intraoperative hypotension

(RR: 1.09; 95% CI: 0.90, 1.32; p = 0.005) and postoperative cognitive dysfunc-

tion (RR: 0.56; 95% CI: 0.37, 0.86; p = 0.007) compared to GA. However, no

statistically significant differences were found between RA and GA regarding

surgical time, anesthesia time, intraoperative transfusion, hospital length, de-

lirium, and mortality. RA can effectively reduce intraoperative blood loss and

the risk of hypotension. Due to the current lack of evidence, no positive effects

of RA on other postoperative outcomes were identified. A rigorously designed,

high-quality study is warranted to determine the impact of anesthesia type on

elderly hip fracture patients.

218 Han et al.

Investigación Clínica 66(2): 2025

Impacto de la anestesia regional vs anestesia general

en los resultados posoperatorios en pacientes ancianos

con fractura de cadera: un meta-análisis.

Invest Clin 2025; 66 (2): 217 – 230

Palabras clave: fractura de cadera; anestesia; ancianos; meta-análisis.

Resumen. El objetivo de este estudio fue utilizar meta-análisis para com-

parar el impacto de la anestesia regional (AR) versus la anestesia general (AG)

en los resultados posoperatorios en pacientes ancianos sometidos a cirugía de

fractura de cadera. Se buscó en las bases de datos electrónicas (PubMed, Web of

Science, Cochrane Library y Embase) ensayos controlados aleatorios (ECA) que

compararan los efectos de AR vs AG en pacientes de edad avanzada sometidos

a cirugía de fractura de cadera. Se utilizó el modelo de efectos aleatorios o fijos

para calcular los riesgos relativos agrupados (RR) y las diferencias de medias

(DM). Se incluyeron 14 ECA con 5.626 pacientes de edad avanzada sometidos a

cirugía de fractura de cadera. El metanálisis indicó que la AR se asoció con una

menor incidencia de pérdida de sangre intraoperativa (DM: -39,7 mL; IC 95%:

-68,61, -10,84; p = 0,007), eventos adversos incluyendo hipotensión intraoperati-

va (RR: 1,09; IC del 95%: 0,90, 1,32; p = 0,005) y disfunción cognitiva posopera-

toria (RR: 0,56; IC 95% : 0,37, 0,86; p = 0,007) comparado con GA. Sin embargo,

no se encontraron diferencias estadísticamente significativas entre AR y AG en

términos de tiempo quirúrgico, tiempo de anestesia, transfusión intraoperati-

va, duración hospital, delirio y mortalidad. La AR puede reducir eficazmente la

pérdida de sangre intraoperatoria y el riesgo de hipotensión. Debido a la actual

falta de pruebas, no se identificaron efectos positivos de la AR en otros resultados

posoperatorios. Se justifica un estudio de alta calidad y rigurosamente diseñado

para determinar el impacto del tipo de anestesia en pacientes ancianos con frac-

tura de cadera.

Received: 21-10-2024 Accepted: 03-05-2025

INTRODUCTION

Hip fracture represents one of the sig-

nificant challenges to healthcare in the 21st

century. It is estimated that approximately

1.6 million people suffered from hip frac-

tures globally in 2000, and this number is

expected to rise to 4.5 million by 2050 due

to the aging global population, imposing a

substantial burden on both families and so-

ciety 1-3. Despite patients receiving optimal

care, the postoperative survival of elderly pa-

tients remains poor 4.

Almost all hip fracture patients undergo

surgical treatment, and the choice of anes-

thesia can influence postoperative recovery

and long-term prognosis 5. The application

of regional anesthesia (RA) and general an-

esthesia (GA) in elderly patients with hip

fractures has been debated. Approximately

60% of elderly patients receive GA, while

40% undergo spinal anesthesia (SA) or nerve

blocks 6,7. RA is favored by clinicians as an

integral part of multimodal analgesia due

to its ease of administration and reduced

opioid consumption compared to GA 8. Pre-

Regional anesthesia vs general anesthesia in hip fracture surgery 219

Vol. 66(2): 217 - 230, 2025

vious studies have shown that RA can reduce

the incidence of postoperative cognitive

dysfunction and the risk of death and ma-

jor complications by limiting anesthesia and

morphine use, compared to GA 9,10. However,

the complexity of RA, the high requirement

for patient cooperation, and potential local

complications have limited its application

in certain situations. GA provides a more

stable anesthetic effect and better surgical

conditions but is associated with physiologi-

cal suppression, postoperative cognitive

dysfunction, and respiratory complications,

raising concerns about its safety in elderly

patients.

In recent years, with the continuous

advancement of anesthetic techniques and

drugs, comparative studies on the applica-

tion of RA and GA in hip fracture surgery in

the elderly have increased. However, existing

results are inconsistent, with some studies

supporting the superiority of RA 9,10, while

others consider GA and RA to have equiva-

lent efficacy 11. This inconsistency may arise

from differences in study design, patient

population heterogeneity, and non-uniform

postoperative assessment standards. This

study aims to systematically evaluate and

compare the efficacy and safety of RA and

GA in hip fracture surgery in older patients

through a meta-analys address. We will

conduct a comprehensive analysis of exist-

ing randomized controlled trials to provide

clinical physicians with a more scientific and

objective basis for decision-making and im-

prove the postoperative outcomes of elderly

patients with hip fractures.

MATERIALS AND METHODS

In accordance with the PRISMA 2020

statement 12, a systematic search was con-

ducted across four electronic databases:

PubMed, Web of Science, Cochrane Library,

and Embase. The search period was from the

databases’ inception to August 20, 2024.

The search strategy included the following

keywords: “Hip fracture,” “General anesthe-

sia,” “Regional anesthesia,” “Conduction

Anesthesia,” “Local Anesthesia,” “Spinal

anesthesia,” OR “Epidural anesthesia.” Ad-

ditionally, targeted literature was identified

by reviewing the reference lists of included

studies.

Inclusion and exclusion criteria

Inclusion criteria: (1) Studies pub-

lished in peer-reviewed journals in Chinese

or English; (2) Study subjects were elderly

patients aged ≥60 years (or with a majority

aged ≥60 years) with hip fractures undergo-

ing surgical treatment; (3) The experimen-

tal group received RA; (4) The control group

received GA; (5) At least one of the following

outcomes was reported: primary outcomes

[surgical time, duration of anesthesia, blood

loss, intraoperative transfusion (in units of

packed red blood cells), and hospital length

(from the day of admission to the day of

discharge)], secondary outcomes [adverse

events (intraoperative hypotension, postop-

erative cognitive dysfunction, intraoperative

delirium, etc.)]; (6) Randomized controlled

trials (RCT).

Exclusion criteria: (1) Non-population-

based studies; (2) Conference papers, case

reports, systematic reviews, and other study

types; (3) Insufficient outcome information

for data analysis; (4) Duplicate reporting of

studies; (5) Studies where full-text articles

could not be obtained.

Studies screening and data extraction

Two researchers independently con-

ducted literature screening based on the in-

clusion and exclusion criteria. Initial screen-

ing was performed by reading the titles and

abstracts of the literature, followed by a full-

text review of potentially eligible studies. In

cases of disagreement between the two re-

searchers, a third researcher was consulted,

and a consensus was reached through dis-

cussion. After the literature screening, two

researchers independently extracted data

according to a predefined data extraction

form, which included information on publi-

220 Han et al.

Investigación Clínica 66(2): 2025

cation details, demographic characteristics

of the study subjects, intervention charac-

teristics, study period, and outcome events.

Quality assessment

The quality of the literature was as-

sessed using the Cochrane Collaboration’s

risk assessment tool13, which evaluates as-

pects such as the method of randomization,

allocation concealment, blinding, complete-

ness of outcome data, selective reporting of

study results, and other sources of bias.

STATISTICAL METHODS

Statistical analysis was performed using

the Revman 5.3 software. Continuous data

were expressed as mean differences (MD), and

the effect size for categorical data was repre-

sented by the relative risk (RR), with the 95%

confidence interval (CI) used to estimate the

range of the effect size. Heterogeneity was

assessed using the I2 statistic and Q-test to

determine the degree of heterogeneity. The

values of I2 <40%, I2 = 40–60%, and I2 > 60%

indicated low, moderate, and high heteroge-

neity, respectively. If I2 was <50% or p>0.1,

a fixed-effect model was used for analysis; if I2

was >50% or p≤0.1, a random-effects model

was used for analysis. If significant hetero-

geneity was present, sensitivity analysis was

conducted to explore the sources of hetero-

geneity. Unless otherwise specified, the sig-

nificance level was set at p<0.05.

RESULTS

Basic information of included studies

After searching the electronic databas-

es, 3792 studies were identified and included

in the literature review process, as shown in

Fig. 1. After excluding 1731 duplicate stud-

ies and 1964 irrelevant studies, 97 studies

were reviewed in full text to determine their

eligibility for this study, and ultimately, 14

qualified studies were included 11, 14-26.

The publication years of the 14 RCTs

spanned from 2003 to 2024, with four studies

originating from China, two multi-country

studies (USA and Canada), and the remain-

ing studies from Israel (n=1), Iran (n=1),

France (n=1), Greece (n=1), Korea (n=1),

USA (n=1) Denmark (n=1) and the UK

(n=1). The 14 studies involved 5626 elderly

patients undergoing hip fracture surgery, of

which 2768 patients received RA, and the re-

maining 2858 patients received GA. The av-

erage age of the study subjects ranged from

62.5 to 85 years, and in four studies, most of

the patients were male (male≥50%). A sum-

mary of the basic information of the includ-

ed studies is presented in Table 1.

Quality of included studies

We utilized the Cochrane Risk of Bias

tool to assess the quality of the included

studies, revealing a significant risk of bias

in the implementation of blinding and a po-

tential risk in allocation concealment, as

shown in Supplementary Figs. 1-2. Overall,

the quality of the included studies was ac-

ceptable.

Surgical time

Eight studies provided results on the

impact of different anesthesia methods on

surgical time for elderly patients with hip

fractures, involving 1,231 patients who re-

ceived RA and 1,245 patients who received

GA. The heterogeneity assessment showed

heterogeneity among the included studies

(I2=87%, p<0.00001), and the random-ef-

fects model was used to evaluate the impact

of RA versus GA on surgical time. The meta-

analysis results indicated no statistically sig-

nificant difference in the impact of the two

anesthesia methods on surgical time (MD:

-3.10; 95%CI: -6.99, 0.79), as seen in Fig. 2.

Anesthesia time

Six studies provided results on the im-

pact of different anesthesia methods on anes-

thesia time for elderly patients undergoing hip

fracture surgery, involving 1,307 patients who

received RA and 1,389 patients who received

GA. The assessment of heterogeneity revealed

Regional anesthesia vs general anesthesia in hip fracture surgery 221

Vol. 66(2): 217 - 230, 2025

Table 1Basic information of eligible studies

study

location

sample -

mean age

male%

ASA

Rasmussen,2003

Denmark

211

217

70.8/71.1

84.36/88.02

I-IV

Hoppenstein,2005

Israel

81.5/83.5

I-III

Parker,2015

158

164

82.9/83.0

19.0/34.8

Shi,2015

China

68.3

Neuman,2016

USA

80.5/62.5

67/83

Haghighi,2017

Iran

66.22/65.98

84/76

I-III

Meuret,2018

France

83/85

11/29

I-III

Tzimas,2018

Greece

77.11/75.09

47.14

I-III

Shin,2020

Korea

118

81.6/80.0

29.3/24.6

Tang,2021

Chia

78.00/76.60

29.1/36.4

II-IV

Table 1. Basic information of eligible studies.

Study Location Sample-RA Sample-GA Mean age Male % ASA

Fig. 1. Literature selection flowchart.

222 Han et al.

Investigación Clínica 66(2): 2025

heterogeneity among the included studies

(I2=69%, p=0.006), and the random-effects

model was used to calculate the pooled effect

size. The results indicated no statistically sig-

nificant difference in the impact of RA versus

GA on anesthesia time for elderly hip fracture

surgery patients (MD: -0.87; 95%CI: -4.25,

2.50), as shown in Fig. 3.

Blood Loss

Five studies provided results on the im-

pact of different anesthesia methods on in-

traoperative blood loss for elderly patients

undergoing hip fracture surgery, involving

1,169 patients who received RA and 1,245

patients who received GA. The assessment of

heterogeneity revealed heterogeneity among

the included studies (I2=97%, p<0.00001),

and the random-effects model was used to

calculate the pooled effect size. The results

showed that, compared to GA, the use of RA

in elderly patients during hip fracture sur-

gery was associated with lower intraopera-

tive blood loss (MD: -39.7 mL; 95%CI: -68.61,

-10.84; p = 0.007), as depicted in Fig. 4.

Intraoperative transfusion

Five studies reported the impact of dif-

ferent anesthesia methods on intraoperative

transfusion for elderly patients undergoing hip

fracture surgery, involving 1,064 patients who

received RA and 1,078 patients who received

GA. The assessment of heterogeneity revealed

heterogeneity among the included studies

(I2=85%, p<0.0001), and the random-effects

Fig. 2. Efficacy of RA and GA on surgery time in elderly patients for hip fracture surgery.

Supplementary Figure 1 Risk of bias graph.

Supplementary Figure 2 Risk of bias summary.

Regional anesthesia vs general anesthesia in hip fracture surgery 223

Vol. 66(2): 217 - 230, 2025

model was used to evaluate the impact of an-

esthesia methods. The meta-analysis results in-

dicated no statistically significant difference in

the impact of the two anesthesia methods on

intraoperative transfusion for elderly hip frac-

ture surgery patients (RR: 0.75; 95%CI: 0.41,

1.36), as illustrated in Fig. 5.

Hospital stay length

Five studies reported the impact of dif-

ferent anesthesia methods on postoperative

hospital stay length for elderly patients who

underwent hip fracture surgery, involving

932 patients who received RA and 1,004 pa-

tients who received GA. The assessment of

heterogeneity revealed heterogeneity among

the included studies (I2=69%, p=0.01), and

the random-effects model was used to cal-

culate the pooled effect size. The results

showed that RA did not have a significant

positive effect on hospital stay length, and

there was no statistically significant differ-

ence in the efficacy between the two anes-

thesia methods (MD: 0.05; 95%CI: -0.38,

0.49), as shown in Fig. 6.

Adverse events

Five studies reported the impact of differ-

ent anesthesia methods on intraoperative hy-

potension for elderly patients undergoing hip

fracture surgery, involving 737 patients who

received RA and 745 patients who received GA.

The meta-analysis based on the random-effects

model showed that RA could significantly re-

duce the risk of intraoperative hypotension

(RR: 0.58; 95%CI: 0.39, 0.85), as depicted in

Fig. 7. Additionally, the analysis of two studies

suggested that RA had an advantage in reduc-

ing the risk of postoperative cognitive dysfunc-

tion (RR: 0.56; 95%CI: 0.37, 0.86). However,

a similar positive effect on cognitive function

was not found in the risk of intraoperative de-

lirium (RR: 1.09; 95%CI: 0.90, 1.32). For seri-

ous adverse events, the impact of RA versus GA

on postoperative mortality was not statistically

significant (RR: 1.01; 95%CI: 0.81, 1.26), as

shown in Fig. 8.

Sensitivity analysis

We conducted a sensitivity analysis by

excluding one study at a time to explore po-

Fig. 3. Efficacy of RA and GA on anesthesia time in elderly patients for hip fracture surgery.

Fig. 4. Efficacy of RA and GA on blood loss (mL) in elderly patients for hip fracture surgery.

224 Han et al.

Investigación Clínica 66(2): 2025

tential bias risks and determine the stability

of the results. After excluding one study 20,

the heterogeneity among the included stud-

ies decreased from 87% to 0% for surgery

time. The meta-analysis based on the fixed-

effect model showed that RA was related to

less surgery time for elderly patients with

hip fractures by approximately (RR=-2.82;

95%CI: -3.88, -1.77, Fig. 9), but its clinical

effect was limited. For intraoperative hypo-

tension, after excluding one study24, the

heterogeneity among the included studies

decreased from 74% to 24%, and the evalu-

ation results based on the combined effect

model indicated that RA could still signifi-

cantly reduce the risk of intraoperative hy-

potension (RR: 0.42; 95%CI: 0.37, 0.48), as

shown in Fig. 10. Additionally, the sensitiv-

ity analysis for anesthesia time, blood loss,

transfusion, and hospital length did not

identify significant sources of heterogeneity,

and there was no change in the direction of

the results, indicating that the analysis re-

sults of this study are robust.

Fig. 5. Efficacy of RA and GA on blood transfusion in elderly patients for hip fracture surgery.

Fig. 6. Efficacy of RA and GA on hospital length of stay in elderly patients for hip fracture surgery.

Fig. 7. Efficacy of RA and GA on intraoperative hypotension in elderly patients for hip fracture surgery.

Regional anesthesia vs general anesthesia in hip fracture surgery 225

Vol. 66(2): 217 - 230, 2025

Fig. 8. Efficacy of RA and GA on cognitive dysfunction, delirium, and mortality in elderly patients for hip

fracture surgery.

Fig. 9. Sensitivity analysis of RA and GA on surgery time in elderly patients for hip fracture surgery.

226 Han et al.

Investigación Clínica 66(2): 2025

DISCUSSION

This study included research compar-

ing the postoperative outcomes of RA and

GA in elderly patients undergoing hip frac-

ture surgery. Using meta-analysis, we evalu-

ated the impact of RA versus GA on surgical

time, anesthesia time, blood loss, intraop-

erative transfusion, hospital stay length, and

adverse events. A total of 14 studies involv-

ing 5,626 elderly patients who underwent

hip fracture surgery were included, of which

2,768 patients received RA, and the remain-

ing 2,858 patients received GA during sur-

gery. The meta-analysis results showed that

RA had a significant positive effect on blood

loss and intraoperative hypotension but did

not find that this anesthesia method signifi-

cantly improved other patient outcomes.

In our study, RA was significantly associ-

ated with a reduced risk of intraoperative hy-

potension, possibly related to its advantage

in maintaining hemodynamic stability. Hypo-

volemia can decrease preload, subsequently

causing a reduction in cardiac output and

organ perfusion. Although GA is still wide-

ly used in hip fracture surgery, various RA

techniques are becoming increasingly popu-

lar. The use of SA in hip fracture surgery has

increased by 50% in the past decade27. SA

can reduce the body’s compensatory ability

to change blood pressure, especially in pa-

tients with complex basic health status and

physical weakness 28. In addition, continuous

spinal anesthesia (CSA), due to its low-dose

medication characteristics, has been proven

to be more effective in maintaining hemody-

namic stability than single-shot spinal anes-

thesia 29,30.

Furthermore, lower doses of spinal an-

esthesia, through synergistic effects with opi-

oids, can provide effective sensory blockage

while minimizing systemic effects, includ-

ing hemodynamic effects 31. Multiple nerve

blocks, as an alternative to spinal anesthesia,

have been used to reduce the occurrence of

hypotension, and some studies have reported

positive effects 32,33. Based on previous re-

search evidence, choosing the appropriate

anesthesia method is of great significance

for improving the postoperative outcomes of

elderly patients with hip fractures. Future re-

search should explore the specific impact of

different anesthesia methods on the postop-

erative recovery of elderly patients and how

to optimize anesthesia strategies to improve

surgical safety and patient satisfaction.

Delirium is an acute neuropsychiatric

syndrome commonly seen in elderly patients

undergoing hip fracture surgery and is asso-

ciated with increased morbidity, mortality,

and medical costs 34,35. However, our study

did not find a significant impact of RA and

GA on the risk of postoperative delirium in

patients. Although large-scale cohort stud-

ies targeting older people have shown that

GA is associated with an increased risk of

postoperative delirium 10, our study results

are similar to previous meta-analysis results,

which did not find that RA or GA affects the

Fig 10. Sensitivity analysis of RA and GA on intraoperative hypotension in elderly patients for hip fracture

surgery.

Regional anesthesia vs general anesthesia in hip fracture surgery 227

Vol. 66(2): 217 - 230, 2025

incidence of postoperative delirium 36,37. De-

lirium-related factors include age, cognitive

impairment, frailty, comorbidities, surgery,

and psychotropic medications, among oth-

ers. Future research should further explore

the efficacy differences of GA and RA in dif-

ferent population subgroups.

This study has the following limita-

tions. First, eight of the 14 studies included

had a sample size of less than 100 in each

arm. Therefore, the results of the studies

included with small sample sizes should be

interpreted with caution. In addition, there

is a particular risk of bias in implementing

blinding and random concealment in the in-

cluded studies, which may be the reason for

the high heterogeneity in some of the study

results. Furthermore, due to the purpose

of the study, the original studies reported

insufficiently on some postoperative out-

comes, making it impossible for this study

to conduct a quantitative evaluation.

CONCLUSION

In our study, compared with GA, RA can

improve the incidence of intraoperative hy-

potension and reduce intraoperative blood

loss in elderly patients undergoing hip frac-

ture surgery. No significant improvement

in other clinical indicators was found for

RA. Due to the limitations of this study, the

more comprehensive evaluation of evidence

regarding RA and GA is still unclear, and

more high-quality prospective studies are

needed to systematically evaluate whether

RA has significant clinical efficacy for elderly

patients undergoing hip fracture surgery.

ACKNOWLEDGMENTS

Not applicable.

Funding

The study is funded by the Hangzhou

Medical and Health Science and Technology

Project (A20220667).

Ethical statement

An ethics statement is not applicable

because this study is based exclusively on

published literature.

Consent for publication

Not applicable.

Availability of data and materials

All data generated or analyzed during

this study are included in this article.

Competing interest

The authors had no separate personal,

financial, commercial, or academic conflicts

of interest.

Number ORCID of author

• Feng Han: 0009-0007-6312-7526

• Yue Yang: 0009-0004-9317-8680

• Xinxin Tian: 0009-0001-9433-0064

Author contributions

HF conceived and designed the study.

HF and TXX took part in the data collection

and did the data analysis. All authors helped

draft the manuscript. All authors helped to

revise the manuscript. All authors read and

approved the final manuscript.

REFERENCES

1. Johnell O, Kanis JA. An estimate of the

worldwide prevalence and disability asso-

ciated with osteoporotic fractures. Osteo-

poros Int. 2006;17(12):1726-1733.

2. Cauley JA, Chalhoub D, Kassem AM, Fu-

leihan Gel-H. Geographic and ethnic dis-

parities in osteoporotic fractures. Nat Rev

Endocrinol. 2014;10(6):338-351.

228 Han et al.

Investigación Clínica 66(2): 2025

3. Marsillo E, Pintore A, Asparago G, Oli-

va F, Maffulli N. Cephalomedullary nailing

for reverse oblique intertrochanteric frac-

tures 31A3 (AO/OTA). Orthop Rev (Pavia).

2022 13;14(6):38560.

4. Hawley S, Javaid MK, Prieto-Alhambra D,

Lippett J, Sheard S, Arden NK, Cooper C,

Judge A; REFReSH study group. Clinical

effectiveness of orthogeriatric and fracture

liaison service models of care for hip fractu-

re patients: population-based longitudinal

study. Age Ageing. 2016;45(2):236-342.

5. National hip fracture database (NHFD).

Annual report 2017. London: Royal Colle-

ge of Physicians; 2017.

6. White SM, Moppett IK, Griffiths R. Outco-

me by mode of anaesthesia for hip fracture

surgery. An observational audit of 65 535

patients in a national dataset. Anaesthesia

2014;69(3):224-230.

7. National Hip Fracture Database. Annual

report, The National Hip Fracture Databa-

se (nhfd.co.uk), 2020. Available from (Ac-

cessed April 21 2022).

8. Zywiel MG, Prabhu A, Perruccio AV, Gan-

dhi R. The influence of anesthesia and pain

management on cognitive dysfunction af-

ter joint arthroplasty: a systematic review.

Clin Orthop Relat Res. 2014;472(5):1453-

1466.

9. Ahn EJ, Kim HJ, Kim KW, Choi HR,

Kang H, Bang SR. Comparison of general

anaesthesia and regional anaesthesia in

terms of mortality and complications in el-

derly patients with hip fracture: a nation-

wide population-based study. BMJ Open.

2019;9(9):e029245.

10. Ravi B, Pincus D, Choi S, Jenkinson R,

Wasserstein DN, Redelmeier DA. Associa-

tion of Duration of Surgery With Postope-

rative Delirium Among Patients Receiving

Hip Fracture Repair. JAMA Netw Open.

2019;2(2):e190111.

11. Li T, Li J, Yuan L, Wu J, Jiang C, Da-

niels J, et al.; RAGA Study Investigators.

Effect of regional vs general anesthesia on

incidence of postoperative delirium in ol-

der patients undergoing hip fracture sur-

gery: The RAGA Randomized Trial. JAMA.

2022;327(1):50-58.

12. Page MJ, McKenzie JE, Bossuyt PM, Bou-

tron I, Hoffmann TC, Mulrow CD, et al.

The PRISMA 2020 statement: an updated

guideline for reporting systematic reviews.

BMJ. 2021;372:n71.

13. Higgins J, Altman DG. Chapter 8: Asses-

sing risk of biasin included studies. In Co-

chrane Handbook for Systematic Reviews

of Interventions Version 5.0 (eds J. Higg-

ins & S. Green), 2008. Available at:http://

www.cochrane-handbook.org (last acces-

sed July 20 2010).

14. Rasmussen LS, Johnson T, Kuipers HM,

Kristensen D, Siersma VD, Vila P, et al.;

ISPOCD2(International Study of Posto-

perative Cognitive Dysfunction) Investi-

gators. Does anaesthesia cause postopera-

tive cognitive dysfunction? A randomised

study of regional versus general anaesthe-

sia in 438 elderly patients. Acta Anaesthe-

siol Scand. 2003;47(3):260-266.

15. Hoppenstein D, Zohar E, Ramaty E, Sha-

bat S, Fredman B. The effects of general

vs spinal anesthesia on frontal cerebral

oxygen saturation in geriatric patients

undergoing emergency surgical fixa-

tion of the neck of femur. J Clin Anesth.

2005;17(6):431-438.

16. Vail EA, Feng R, Sieber F, Carson JL,et al ;

REGAIN (Regional versus General Anesthe-

sia for Promoting Independence after Hip

Fracture) Investigators. Long-term Outco-

mes with Spinal versus General Anesthesia

for Hip Fracture Surgery: A Randomized

Trial. Anesthesiology. 2024;140(3):375-

386.

17. Parker MJ, Griffiths R. General versus

regional anaesthesia for hip fractures. A

pilot randomised controlled trial of 322

patients. Injury. 2015;46(8):1562-1566.

18. Shi HJ, Xue XH, Wang YL, Zhang WS,

Wang ZS, Yu AL. Effects of different

anesthesia methods on cognitive dys-

function after hip replacement operation

in elder patients. Int J Clin Exp Med.

2015;8(3):3883-3888.

19. Neuman MD, Mehta S, Bannister ER,

Hesketh PJ, Horan AD, Elkassabany

NM. Pilot randomized controlled trial

of spinal versus general anesthesia for

Regional anesthesia vs general anesthesia in hip fracture surgery 229

Vol. 66(2): 217 - 230, 2025

hip fracture surgery. J Am Geriatr Soc.

2016;64(12):2604-2606.

20. Haghighi M, Sedighinejad A, Nabi BN,

Mardani-Kivi M, Tehran SG, Mirfazli SA,

et al. Is spinal anesthesia with low dose li-

docaine better than sevoflorane anesthesia

in patients undergoing hip fracture Sur-

gery. Arch Bone Jt Surg. 2017;5(4):226-

230.

21. Meuret P, Bouvet L, Villet B, Hafez M,

Allaouchiche B, Boselli E. Hypobaric uni-

lateral spinal anaesthesia versus general

anaesthesia in rlderly patients undergoing

hip fracture surgical repair: a prospective

randomised Open Trial. Turk J Anaesthe-

siol Reanim. 2018;46(2):121-130.

22. Tzimas P, Samara E, Petrou A, Korom-

pilias A, Chalkias A, Papadopoulos G.

The influence of anesthetic techniques

on postoperative cognitive function in el-

derly patients undergoing hip fracture sur-

gery: General vs spinal anesthesia. Injury.

2018;49(12):2221-2226.

23. Shin S, Kim SH, Park KK, Kim SJ, Bae

JC, Choi YS. Effects of anesthesia techni-

ques on outcomes after hip fracture sur-

gery in elderly patients: A prospective,

randomized, controlled trial. J Clin Med.

2020;9(6):1605.

24. Tang L, Fang P, Fang Y, Lu Y, Xu G, Liu X.

Comparison of effects between combined

lumbar-sacral plexus block plus general

anesthesia and unilateral spinal anesthesia

in elderly patients undergoing hip fractu-

re surgery: A pilot randomized controlled

trial. Evid based complement alternat

med. 2021;2021:6685497.

25. Neuman MD, Feng R, Carson JL, Gaskins

LJ, Dillane D, Sessler DI, et al.; REGAIN

Investigators. Spinal anesthesia or general

anesthesia for hip surgery in older adults.

N Engl J Med. 2021;385(22):2025-2035.

26. Zhang A, Gao H, Lu Y, Jiang L, Xu C. Fascia

iliaca block combined with low-dose spinal

anesthesia for hip fracture surgery in the

elderly: effects on severe hypotension and

analgesia. A randomized controlled trial.

Pain Physician. 2024;27(5):E579-E587.

27. Maxwell BG, Spitz W, Porter J. Associa-

tion of increasing use of spinal anesthe-

sia in hip fracture repair with treating

an aging patient population. JAMA Surg.

2020;155(2):167-168.

28. Boddaert J, Raux M, Khiami F, Riou B.

Perioperative management of elderly pa-

tients with hip fracture. Anesthesiology.

2014;121(6):1336-1341.

29. Biboulet P, Jourdan A, Van Haevre V,

Morau D, Bernard N, Bringuier S, et al.

Hemodynamic profile of target-controlled

spinal anesthesia compared with 2 target-

controlled general anesthesia techniques

in elderly patients with cardiac comorbidi-

ties. Reg Anesth Pain Med. 2012;37(4):433-

440.

30. Futier E, Lefrant JY, Guinot PG, Godet

T, Lorne E, Cuvillon P, et al.; INPRESS

Study Group. Effect of individualized vs

standard blood pressure management stra-

tegies on postoperative organ dysfunction

among high-risk patients undergoing ma-

jor surgery: A eandomized clinical trial.

JAMA. 2017;318(14):1346-1357.

31. Messina A, La Via L, Milani A, Savi M,

Calabrò L, Sanfilippo F, et al. Spinal

anesthesia and hypotensive events in hip

fracture surgical repair in elderly patients:

a meta-analysis. J Anesth Analg Crit Care.

2022;2(1):19.

32. de Visme V, Picart F, Le Jouan R, Legrand

A, Savry C, Morin V. Combined lumbar

and sacral plexus block compared with

plain bupivacaine spinal anesthesia for hip

fractures in the elderly. Reg Anesth Pain

Med. 2000;25(2):158-162.

33. Johnston DF, Stafford M, McKinney M,

Deyermond R, Dane K. Peripheral nerve

blocks with sedation using propofol and al-

fentanil target-controlled infusion for hip

fracture surgery: a review of 6 years in use.

J Clin Anesth. 2016;29:33-39.

34. Yang Y, Zhao X, Dong T, Yang Z, Zhang

Q, Zhang Y. Risk factors for postoperati-

ve delirium following hip fracture repair

in elderly patients: a systematic review

and meta-analysis. Aging Clin Exp Res.

2017;29(2):115-126.

35. Inouye SK, Bogardus ST Jr, Charpentier

PA, Leo-Summers L, Acampora D, Holford

TR, et al. A multicomponent intervention

230 Han et al.

Investigación Clínica 66(2): 2025

to prevent delirium in hospitalized older pa-

tients. N Engl J Med. 1999;340(9):669-676.

36. Patel V, Champaneria R, Dretzke J, Ye-

ung J. Effect of regional versus general

anaesthesia on postoperative delirium in

elderly patients undergoing surgery for hip

fracture: a systematic review. BMJ Open.

2018;8(12):e020757.

37. Guay J, Parker MJ, Gajendragadkar PR,

Kopp S. Anaesthesia for hip fracture sur-

gery in adults. Cochrane Database Syst

Rev. 2016;2(2):CD000521.