Effect of various anesthesia methods on surgical treatment outcomes in patients with proximal femur fracture: a narrative review

Abstract

Fractures of the proximal femur (FPF) is an unclassified condition that involves fractures of the femoral head and femoral neck and transvertebral, intervertebral, and subvertebral femoral fractures. To date, the number of patients with FPF in Russia is continuously increasing. Most often, patients with FPF have several concomitant diseases that can have a noticeable effect on the choice of anesthesia method. This review aimed to analyze current literature data on the advantages, risks, and contraindications of traditional and novel approaches to anesthesia in surgeries for FPF and assess the impact of these approaches on postoperative outcomes. A search for publications in the electronic databases PubMed and eLibrary was conducted. It revealed 6 324 publications in PubMed and 520 in eLibrary. After selecting publications, 60 studies meeting the inclusion criteria were included in the review. Studies have shown that regional blockades are highly effective; however, the evidence requires additional confirmation. New local anesthesia methods, such as MAC-STILA, can reduce mortality, especially in patients with a burdened medical history. Although the results of the single-center pilot studies of MAC-STILA are promising, multicenter randomized trials are required to test the reproducibility of this approach and evaluate its effectiveness with respect to outcomes that are crucial for the elderly and their family members.