Combination of a fascia iliaca block with low-dose low-specific-gravity spinal anaesthesia versus general anaesthesia for hip fracture surgery in the elderly: a randomised controlled trial

Abstract

Abstract Introduction Hip fractures are increasingly prevalent in ageing populations globally. Surgery is required, necessitating anaesthesia. Intraoperative hypotension adversely impacts outcomes regardless of anaesthetic type. This randomised controlled trial aimed to evaluate severe hypotension incidence with fascia iliaca block (FIB) combined with low-dose, low-specific-gravity spinal anaesthesia (LLSA) versus general anaesthesia (GA) for hip fracture surgery in the elderly. Methods In this single-centre, randomised controlled trial, 68 geriatric hip fracture patients were allocated to receive either FIB + LLSA or GA. The primary outcome was severe hypotension incidence, defined as mean arterial pressure (MAP) < 65 mmHg for > 12 consecutive minutes. Secondary outcomes included vasopressor quantity, pain scores, rescue analgesia requirements, complications, and surgery characteristics. Results Severe hypotension occurred less frequently with FIB + LLSA (32.4%) than GA (67.6%) (OR 2.9; 95% CI 1.4-6.0; P = 0.004). Pain scores, rescue analgesia needs, nausea incidence, and hospital stay were lower with FIB + LLSA (all P < 0.05). No between-group differences occurred in complications or mortality. Conclusion For elderly hip fracture surgery, FIB + LLSA reduced severe hypotension, improved analgesia, and enabled earlier hospital discharge versus GA. FIB + LLSA appears advantageous for this population.