The effect of various anesthesia methods on the outcomes of surgical treatment of patients with a fracture of the proximal femur



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Abstract

Fractures of the proximal femur (FPF) is an unclassified concept that combines fractures of the femoral head, fractures of the femoral neck, transvertebral, intervertebral and subvertebral femoral fractures. To date, the number of patients with FPF in the Russian Federation is steadily increasing. Most often, patients with FPF have a large number of concomitant diseases that can have a pronounced effect on the choice of anesthesia method. The purpose of the review is to analyze current literature data on the assessment of the advantages, risks and contraindications of traditional and new approaches to anesthesia in operations for FPF, as well as to assess the impact of these approaches on postoperative outcomes. The authors conducted a search for publications in the electronic databases PubMed and eLibrary. The search results revealed 6324 in the PubMed database and 520 in the eLibrary. After the selection of publications, 58 studies meeting the inclusion criteria were included in the review. Studies have shown that regional blockades are highly effective, but the evidence requires additional confirmation. New methods of local anesthesia, 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 needed to test the reproducibility of this approach and evaluate its effectiveness with respect to outcomes that are important for the elderly and their family members, including postoperative delirium, mobility and functional recovery.

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