Abstract
Background
The geriatric population presents unique challenges in the perioperative setting due to age-related physiological changes, comorbidities, and altered drug responses. Adapting anesthesia to the particular requirements of elderly patients is crucial for maximizing the success of surgical procedures and reducing the risk of complications and death during the perioperative period; this systematic review aims to assess the selection of anesthetic methods and medications used in upper limb surgeries for elderly patients. By compiling and analyzing data from existing published research, the review seeks to clarify the relative effectiveness, safety, and potential outcomes of various anesthesia techniques used in older individuals undergoing surgeries on the upper extremities.
Methods
Our study employed a systematic review methodology following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study evaluated anesthesia techniques and drugs for upper limb surgery in older adults. Articles were identified through WEB of SCIENCE, MEDLINE, PUBMED, CINAHL searches, and Hand-Searching from January 2000 to January 2024, with eligibility criteria targeting studies on anesthesia for upper extremity surgeries only in older adults ≥ 65 years. Data extraction included study characteristics and outcomes related to anesthesia techniques and drugs. The methodological quality of included studies was assessed using the Cochrane risk-of-bias tool for randomized trials and the ROBINS-I tool for non-randomized studies of interventions.
Results
18 articles met the inclusion criteria for the systematic review. The effectiveness of regional anesthesia is influenced by several factors. The addition of upper-extremity peripheral nerve blocks to general anesthesia during total shoulder arthroplasty has been shown not to increase the risk of complications or resource utilization. In arteriovenous fistula surgery, the application of a brachial plexus block for anesthesia has been shown to increase tissue oxygenation, as indicated by Near-Infrared Spectroscopy. Rotator cuff surgery pain management now favors continuous supraclavicular block, offering comparable pain relief to interscalene block but with fewer side effects
Conclusion
The review emphasizes the significance of selecting appropriate anesthesia techniques and drugs for upper limb surgery in elderly patients to enhance surgical outcomes and reduce perioperative complications.